1
Application form for Para ice hockey players
1.1
Contact Information
Please provide the following information about the candidate.
Participant name:
Street address:
Postal code:
City, Province/state:
Country:
Telephone:
Email:
National Paralympic Committee:
Date of birth (dd/mm/yyyy): :
Age:
1.2
Application Questions
Answers to these questions will be considered along with your resume/curriculum vitae and
letter of support.
1. What is your current status as an athlete within your nation and/or on an international level?
When did you start training Para ice hockey? What is your skill level? How often do you train?
2. What is your ambition as an athlete, what would you like to achieve?
3. Do you have any notable results in Para sport?
City, Country
Tournament/Event
result
4. Please have a doctor fill in the Medical Diagnostic Form (attached)
2
Submitting your application
Step 1: Save this application form document in your computer using the applicant’s name as the file
name and send it as an attached word document via email to [email protected] and
[email protected]
Step 2: In addition, send the documents below via email to [email protected] and
[email protected]. Incomplete applications will not be considered.
 A supporting letter signed by the NPC representative.
3
Contact details
More information regarding the workshops will be sent in due time to the selected
participants. In case of any questions please do not hesitate to send an email to:
Jose Cabo
Development Senior Manager
(Agitos Foundation)
Teléfono: +49 228 2097-225
Email: [email protected]
Adenauerallee 134
53113 Bonn, Alemania
www.agitosfoundation.org
And
Benoit Struys
Sport Technical Programmes Coordinator
(Agitos Foundation)
Telephone: +49 228 2097-133
Email: [email protected]
Adenauerallee 134
53113 Bonn, Germany