Before completing this form, please ensure you ... - Amazon S3



Before completing this form, please ensure you have read the CSSC Sponsorship Scheme ‘Notes to Applicants’ which give details of the scheme and information required from applicants. If you require any advice or assistance on the completion of this form, please contact CSSC on 01494 888 413 or email linda.irwin@cssc.co.uk

Section 1

Please complete this section in full using BLOCK CAPITALS (Incomplete forms may cause delay).

|Surname | |

|First Name(s) | |

|Date of Birth | |

|CSSC Membership Number | |

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|Contact Details |

|Employer (if appropriate) |Home |

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|Employer Address |Address |

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|Postcode |Postcode |

|Tel: |Tel: |

|Email: |

|What is the sport, activity or pastime that this application relates| |

|to? | |

|This scheme is targeted at assisting members with disabilities or | Disability |Please select one of the three |

|those who are facing financial hardship. Please confirm under what | |options |

|basis you are applying … | | |

| | Hardship | |

| | Both | |

|Is there a firm date by which you need to have a decision on this |Yes / No (please delete as appropriate) |

|application? | |

|If yes, please specify the date and reason(s) | |

Section 2

To help CSSC’s Sports and Leisure Committee consider your application, it is important that all questions are answered. Other information, e.g. press cuttings, evidence of performance, entry forms, cost of courses, may also be submitted, but please make it clear if you wish this material to be returned to you.

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|Have you been a member of CSSC for at least one year? Please tick relevant box |

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|Yes No |

|If ‘Yes’, please state how long years |

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|2.2 Do you take part in any CSSC events, teams or activities Please tick relevant box |

|or fulfil any role as a CSSC organiser or official? |

|If 'Yes', please provide details. |

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|Yes No |

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|2.3 Have you previously received any financial assistance, prize Please tick relevant box |

|money or sponsorship from CSSC or any other source? |

|If 'Yes', please provide details. |

|Yes No |

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|Amount(s) Source Date(s) |

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|Over the past 12 months, have you applied for financial assistance |

|from your CSSC Area Association? Yes No |

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|Over the past 12 month, have you applied for financial assistance |

|from your CSSC Departmental Association? Yes No |

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|Achieving your Ambition: |

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|What is your main sporting, leisure or recreational ambition? |

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|If you are seeking help with the costs of a coaching, refereeing or similar course, what courses have you already taken and at what level? |

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|What plans do you have to achieve your ambition and what timescales do you realistically think will be needed? |

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Section 3

3.1 Cost

Please provide an estimate of the normal annual costs you incur when taking part in your chosen sport or activity.

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|Costs per year |Explanations / Notes (as appropriate) |

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|Equipment £ | |

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|Clothing £ | |

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|Hire of facilities £ | |

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|Travel £ | |

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|Coaching / tuition £ | |

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|Other expenses £ _______________ | |

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|Total | |

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3.2 Your Ambition costs

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|Please tell us about the particular project, item, course or need for which you are seeking CSSC’s assistance. |

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|Please detail any other expenditure that you are planning or hoping to commit to in order to progress within your chosen sport or |

|activity, that will help improve your performance, or will help you to gain a relevant qualification. |

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Section 4

4. This section should only be completed if you are applying for assistance on the grounds of disability

|To help with your application, we need to understand how any disability you may have impacts on your participation in the activity in |

|question. |

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|Please be assured that CSSC has no desire to pry unnecessarily into your personal circumstances. However, please be as specific has you |

|can as this will avoid the need to ask supplementary questions or to seek clarification. You can find more guidance about this section |

|on the ‘Notes to Applicants’ handout. |

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|When considering your application and only if it is relevant, CSSC may request additional information to clarify your circumstances. |

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Section 5

5. This section should only be completed if you are applying for assistance on the grounds of hardship

|To help with your application, we need to understand how any financial difficulties you are currently faced with impact on your ability to|

|pursue realistic goals in your chosen activity. It is important that you are specific as possible. Simply indicating that you might be |

|‘struggling to make ends meet’ is not in itself unusual and fails to give a clear picture. |

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|If you are faced with a significant reduction in income, unexpected financial burdens, in receipt of any form of means tested benefit or |

|are operating to a formal debt plan then please give details. Even if these things do not apply to you, please be as clear and specific |

|about your circumstances to help the panel understand why you are currently faced with hardship and gain some appreciation of the extent |

|of that hardship. |

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|Please be assured that CSSC has no desire to pry unnecessarily into your personal circumstances. When considering your application and |

|only if it is relevant, CSSC may request additional information to clarify your circumstances. |

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|5.1 How much disposable capital does your household have? |

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|(NB – Household includes any partner living with you. Disposable capital includes all savings; investments; stocks and shares, redundancy |

|capital, second homes, etc both you and, if you have one, your partner) |

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|5.2 Gross Monthly Household Income: |

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|Are you in a couple? Please tick relevant box |

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|Yes No |

|How many children under 18 do you have? |

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|Please Complete the following – |

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|Your gross monthly income |

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|Your Partner’s gross monthly income |

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|Income from any other people living with you |

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|Any pension you receive |

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|Child Benefit |

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|Any other benefits (please specify type list of exclusions available) |

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|Any other source of income |

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|Total gross monthly household income |

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|5.4 Please tell us about anything else to do with your finances that you think we should know when making a decision. |

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Section 6

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|6.1 Would you be willing to pass on your skills to others? Please tick the relevant box |

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|Please give brief details |

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|Yes No |

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|6.2 Do you or will you make charges for your services, Please tick the relevant box |

|e.g. by coaching or by taking classes? |

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|Please give brief details |

|Yes No |

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|6.3 If you are applying for a grant to attend a course Please tick the relevant box |

|or improve your qualifications, would you subsequently |

|be able to make a charge for your services? |

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|Please give details Yes |

|No |

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What to do next?

When completed, forward this form to either by email to linda.irwin@cssc.co.uk or by post to CSSC Sponsorship Scheme, Compton Court, 20-24 Temple End, High Wycombe, Bucks, HP13 5DR

Your application will be acknowledged and then passed to members of CSSC’s Sports & Leisure Committee for consideration. All applicants will receive a final decision on their application within 6 weeks, though it is expected that in most cases the turnaround time will be within one month if the initial application is fully complete.

Data Protection Act

The 2018 Data Protection Act defines your rights as an individual in relation to the information held about you and how it may be used.

CSSC takes its responsibilities in respect of data protection very seriously and takes the utmost care when using data related to members. The most important reason for holding the information that you have provided, is to process your application for assistance. CSSC needs to keep your data on a computer and in paper files for this purpose. In exceptional circumstances CSSC may need to share some information with a third party, but this will only be directly connected with your application for sponsorship and to inform the consideration process. Any information shared will be kept to the absolute minimum to resolve the point at issue. By way of example, this may be another sponsoring body or governing body of sport. The information we hold may be updated by yourself, or by a third party working on your behalf, at any time.

We may also use some of the information for accounting, audit, statistical or research purposes (e.g. to make sure CSSC is offering the right sort of services), but it may only be used internally within CSSC or under contract for use exclusively by CSSC. We will not disclose any of your information outside CSSC, other than as mentioned above, unless you have given us your prior consent.

We undertake to keep your information strictly confidential and to do everything we can to prevent the information being used in any unauthorised or unlawful way.

With respect to the more sensitive areas of data, e.g. health or financial issues, we need your explicit consent to hold this information. Please sign this form to agree to us using the data you have supplied so that your application for assistance can be processed. Without your consent, we will be unable to process this application.

You also have the right to request a copy of the information we hold about you; we will provide all of this data except any that refers to another person.

For more information on how we process personal data, please see CSSC’s Privacy Policy

If you have any queries about the use we make of your data, please contact CSSC on 01494 888413

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|I agree to CSSC using my data as outlined above. Signed |

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|Date |

Please sign (or indicate your agreement electronically) and return this form with your application form.[pic]

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Application Form

CSSC Sponsorship Scheme

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I declare that all questions have been fully and truthfully answered to the best of my knowledge.

Signed ___________________________ Date ____________

6.4 Please describe how you would benefit from a CSSC

Sponsorship award.

Applicants Checklist:

• Have you read the ‘Notes to Applicants’?

• Have you been a CSSC member for at least one year?

• Have you provided sufficient information about cost?

• Have you outlined and costed a clear need or project for which you are requesting assistance?

• Have you fully completed and signed the form?

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