Application form for World Para Swimming Level 2 PI Classifier
Programme (Copenhagen, Denmark)
World Para Swimming would like to thank you for your interest in participating in our education
programmes. Please submit the below fully completed form including any necessary
attachments to IPC Summer Sports Education Co-ordinator. Before filling in the form, please
carefully read the below programme details:
Programme dates:
Arrival date:
04 March 2017
Programme dates:
05 – 07 March 2017
Departure date:
08 March 2017
Programme location:
Copenhagen, Denmark
Programme code:
SW2CL DEN
Participant fee:
315 EUR or 687 EUR (see chart below)
After selection to the programme the candidate will be sent an invoice for the participant fee
and a voucher code for the Level 1 PI Classifier Course (online). Once the participant fee is paid
for the participant has confirmed his attendance and cannot be refunded.
Please note that as a participant of the programme it will be your responsibility to arrange flights
and ground transport as well as any insurance that you may need (e.g. medical, liability). It may
also be your responsibility to arrange accommodation, breakfast and dinner, depending on the
participant fee that you choose:
365 EUR
675 EUR
•
Costs associated with the training
•
Costs associated with the training
•
Voucher code for Level 1 PI Classifier
•
Voucher code for Level 1 PI Classifier
Course (online) (value of 53.50 EUR)
•
3* coffee break and lunch
Course (online) (value of 53.50 EUR)
•
3* coffee break and lunch
•
4 hotel nights (single room) at:
http://www.idraettenshus.dk/
•
3* dinner
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Candidate profile for the programme:
Candidates must have:
• completed the Level 1 PI Classifier Course (online) before start of this programme
• interest in Paralympic sports and specifically Swimming
• desire to serve as a National Classifier in current country of residence
Candidates preferably should also have one of these qualifications:
• a certified health professional which World Para Swimming at its sole discretion deems
acceptable, e.g. physicians and physiotherapists; or
• an extensive coaching or other relevant background in the sport of World Para Swimming
or a recognised and reputable academic qualification which encompasses a requisite
level of anatomical, biomechanical and sport-specific expertise, which World Para
Swimming at its sole discretion deems to be acceptable
Please write down your details:
Programme code:
Participant fee selected:
SW2CL DEN
365 EUR
675 EUR
Last name:
First name:
Gender:
Nationality:
Date of Birth:
Full address:
(street, city, ZIP code, country)
Email address:
Mobile phone number:
What is your native language?
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Are you fluent in English?
No
Yes
No
Yes
What is your profession?
What are your qualifications
(e.g. university degree, professional
certifications)?
Do you have the support of your NPC
to participate in this programme?
If yes, which is your NPC?
If yes, NPC contact person name:
If yes, NPC contact person email:
Documents attached to this form:
Any certificates proving qualification as outlined
in candidate profile above (e.g. medical
certificate, coaching certificates)
Any other relevant certificates (e.g. previous
Classification programmes attended)
If you have experience as a [PI Classifier], please list your experience below (e.g.
competitions officiated at, type and number of athletes classified):
If you have any experience with para sport in other roles than Technical Official or
Classifier for Swimming, please provide a brief description below (e.g. para sport coach,
team official, Classifier for another sport than swimming):
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National Paralympic Committee (NPC) / National Swimming Federation (NF) affiliation:
I confirm that I do not hold a paid or volunteer position in a NPC / NF or national team.
I acknowledge my affiliation to a NPC / NF or national team. Please specify:
Signature of the applicant: ___________________________________________________
Below only to be filled out by applicants who are in touch with their NPC / NF:
Name of the NPC / NF:
___________________________________________________
NPC / NF signature:
___________________________________________________
NPC / NF stamp:
Invoicing instructions for participant fee (if different from contact details above):
Name/Organisation:
Full address:
(street, city, ZIP code, country)
Email:
Please return your application form no later than 27 January 2017 to:
By email:
[email protected] AND [email protected]
By fax:
+49 228 2097 167
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