Low Income Coach Bursary Application

Personal Information

First Name *

Last Name *

Gender *

Man

Woman

Non binary/Genderqueer/Gender Fluid

Two-spirit

Prefer not to answer

Address *

City/Town *

Postal Code *

Email *

Phone Number *

Total Family Size

Did you pay for the workshop?

Yes – Option 1

No, my club/organization subsidized the cost – Option 2

Supporting Documents

Identification

Maximum upload size: 52.43MB

One of the following: Birth Certificate, Canadian Citizenship or Permanent Resident Card, Certificate of Indian Status, Passport, Immigration and refugee document issued by Citizenship and Immigration Canada, Ontario Driver’s License, Ontario Health Card (with name and DOB) or Ontario Photo Card

Address

Maximum upload size: 52.43MB

One of the following: Lease/Rental Agreement, Current Utility Bill, Current Child Tax Benefit Statement, Current Bank Statement, Mortgage Statement, Property Tax Bill, Ontario Driver’s License or Ontario Photo Card

Income

Maximum upload size: 52.43MB

One of the following: CRA Notice of Assessment with line 150 (must include name, address, tax year as well as page with line 150 – (total income)), Ontario Disability Support Program statement, residents receiving any forms of Canadian Pension such as Canadian Pension Plan (CPP), Old Age Security (OAS), Guaranteed Income Supplement (GIS) and Ontario Guaranteed Annual Income System (GAINS) must submit current year Notice of Assessment to prove total income, employment insurance (EIB), Pay stub(s) showing income for the last 30 days.

Club/Organization Information

Club/Organization

Cheque will be addressed to this name

Club/Organization Contact Name

Club/Organization Contact Phone Number

Club/Organization Contact Email

Club Address

This is the address your cheque will be mailed to

City/Town

Postal Code

Coaching Information

Select Your Sport *

NCCP # *

Enter 00000 if you do not have a number. To get a NCCP# visit https://www.coachesontario.ca/nccp-training/getting-your-nccp/

Please provide a brief outline of your coaching background and the level of competition you coach *

Coach Training Information

I am applying for a bursary for the following: *

Workshop/Course/Training Only

Both Workshop/Course/Training and Evaluation

Evaluation includes a portfolio and observation.

Course or Workshop Name *

What NCCP are you completing? *

Date of Workshop Completion *

Must be between April 1, 2022 and March 31, 2023

Course Fee (Numeric characters only – do not enter a “$” sign) *

Receipt required for bursary

Learning Facilitator Name

Location *

What is the competitive level of the individuals that you coach? *

Community

Provincial

National/International

Disclaimer Acknowledgement

By checking this box, I certify that I am a current member in good standing with a recognized PSO/MSO and assigned as the coach of athletes to attending competitions and a resident of Ontario. *

Yes

By checking this box, I certify that I am the person named above, and that all information provided is true and accurate. *

Yes

Steps to access the Low Income Coach Bursary

Personal Information

Supporting Documents

Club/Organization Information

Coaching Information

Coach Training Information

Disclaimer Acknowledgement