Regional Athlete Support Program

Application form

To apply for the Regional Athlete Support Program, please complete the application form below.

Full name

Date of birth

Address

Phone number

How would you describe your gender

Do you identify as being of Aboriginal or Torres Straight Islander descent?

In which region do you live?

Parent/guardian name

Parent/guardian phone number

Parent/guardian email

Sport you play

Name of the State sporting association (SSA) that is supporting your application

Name of contact person at SSA

Position held at SSA

Name of coach

Email of coach

Describe your recent achievements in your sport and how you think you meet the scholarship criteria

What can your local talent development program do to help you achieve these goals?

Describe your goals for the next 12 months

I confirm that the High Performance Manager or approved representative of the State sporting association and/or the regional sports association endorse and support this application

Yes

I certify that the information provided in this application is true and correct

Yes

Page reviewed 01 September 2025

Regional Athlete Support Program

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