VICTORY SCHOLAR
APPLICATION FORM
APPLY TO BE A VICTORY SCHOLAR
Applications for the upcoming academic year of the
Sport Changes Life Victory Scholar Program, support
by the Rory Foundation, are now OPEN for application.
The closing date is available on our website on the
Victory Scholar Application Page, so make sure you
apply for your chance to join the Sport Changes Life
family and make your first steps on the road to Victory.
Please fill all sections of the application form in full to
maximise your chances of becoming the newest member
of the Sports Changes Life Victory Scholar Family.
For any queries please contact Victory Coordinator
Aimee Shiels [email protected].
PERSONAL INFORMATION
First Name
Last Name
Date of Birth
Email
Phone
Skype Name
Your Address
ACADEMIC INFORMATION
Name of University
Address of University
Head Coach Name
Head Coach Email
Name of Academic Co-ordinator
Academic Co-ordinator Email
Course of Study
Start Date
Date of Graduation
Final GPA
SPORTS CHANGES LIFE / VICTORY SCHOLAR APPLICATION
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Which Division are you in?
Division 1
Specific Sports
Division 2
Secondary Sports
Division 3
Name of your Athletic Conference
Did you ever receive a suspension/punishment for
behaviour when at University?
Yes
No
OTHER INFORMATION
Can you provide evidence of your financial need situation?
Did you qualify for financial aid when at University?
Yes
No
Yes
How many of your immediate family
have received third level education?
Have you got a criminal record?
Yes
No
Have you been, or are currently
involved in voluntary work/service?
Do you have coaching experience?
Yes
No
No
Yes
No
Details of coaching experience. Please note that one off session should not be included.
Summer Camps
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Elementary Schools
AAU Teams –
please specify ages
Youth Groups
High School
Sunday Schools/Church Groups
Middle School
Community Club
Junior Varsities
Other
If Other please specify, or if AAU teams please specify ages
What voluntary/community work have you undertaken? Please note that one off session should not be included.
Mandatory Community
Work for College
Community
Work
Voluntary work
through College
Voluntary Work
through High School
Community
Outreach
Other
If Other please specify
What leadership/management roles have you had?
SPORTS CHANGES LIFE / VICTORY SCHOLAR APPLICATION
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How did you hear about the Victory Sports Scholarship Program?
Friend
Coach
Past Victory Scholar
University/College
Academic Advisor
Athletic Conference
Word of Mouth
Search Engine
International Office
at University
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Other
What attracts you to the Victory Scholar Program? Please rank
in order of importance to you, 1 being the most important.
Choices:
• Playing Overseas • Coaching • Extended Education
• The chance to travel • Mentoring Youth • An International Experience
e.g. 1) Playing overseas, 2) Coaching, etc...
What are your long-term professional aspirations, how will
the Victory Scholar Program assist you in achieving them?
List your academic achievements. For example being on the Dean’s list.
List your sporting achievements. For example, Honors roll, Captain and MVP.
SPORTS CHANGES LIFE / VICTORY SCHOLAR APPLICATION
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Who has been your greatest influence and why? (No more than 500 words)
Why should you be a Victory Scholar? (No more than 500 words)
SPORTS CHANGES LIFE / VICTORY SCHOLAR APPLICATION
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ACADEMIC REFEREE 1
Name
Email
Address
Contact Number
Relationship
ACADEMIC REFEREE 2
Name
Email
Address
Contact Number
Relationship
Please submit your completed application to
[email protected]
or post the completed hard copy version to:
F.A.O Victory Coordinator
Sport Changes Life
78 Mersey Street
Belfast,
BT4 1EY
Northern Ireland
SPORTS CHANGES LIFE / VICTORY SCHOLAR APPLICATION
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