actas/netball act academy athlete information pack...

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ACTAS/Netball ACT Academy Athlete Information Pack And Selection Policy CONTENTS 1. PROGRAM OVERVIEW..................................................................................................................... 2 2. SELECTION PHILOSOPHY ................................................................................................................. 3 3. ELIGIBILITY CRITERIA ....................................................................................................................... 3 4. SELECTION PANEL ........................................................................................................................... 4 5. SELECTION CRITERIA ....................................................................................................................... 4 6. SQUAD FORMATION ....................................................................................................................... 4 7. KEY DATES ....................................................................................................................................... 5 8. APPEALS PROCESS ........................................................................................................................... 5 9. POWER TO AMEND ......................................................................................................................... 5 APPENDIX 1 – 2014 SELECTION REQUIREMENTS.................................................................................... 6 APPENDIX 2 – PROGRAM SELECTION CRITERIA ...................................................................................... 7 APPENDIX 3 – 2014 KEY DATES ............................................................................................................. 19 APPENDIX 4 – NOMINATION FORM...................................................................................................... 20 APPENDIX 5 – APPLICATION FOR EXEMPTION...................................................................................... 22

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Page 1: ACTAS/Netball ACT Academy Athlete Information Pack …s3-ap-southeast-2.amazonaws.com/netball-wp-assets/wp-content/... · Netball Australia Netball ACT To deliver a world ... International

ACTAS/Netball ACT Academy

Athlete Information Pack

And Selection Policy

CONTENTS

1. PROGRAM OVERVIEW ..................................................................................................................... 2

2. SELECTION PHILOSOPHY ................................................................................................................. 3

3. ELIGIBILITY CRITERIA ....................................................................................................................... 3

4. SELECTION PANEL ........................................................................................................................... 4

5. SELECTION CRITERIA ....................................................................................................................... 4

6. SQUAD FORMATION ....................................................................................................................... 4

7. KEY DATES ....................................................................................................................................... 5

8. APPEALS PROCESS ........................................................................................................................... 5

9. POWER TO AMEND ......................................................................................................................... 5

APPENDIX 1 – 2014 SELECTION REQUIREMENTS .................................................................................... 6

APPENDIX 2 – PROGRAM SELECTION CRITERIA ...................................................................................... 7

APPENDIX 3 – 2014 KEY DATES ............................................................................................................. 19

APPENDIX 4 – NOMINATION FORM ...................................................................................................... 20

APPENDIX 5 – APPLICATION FOR EXEMPTION...................................................................................... 22

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1. PROGRAM OVERVIEW

The ACTAS/Netball ACT Academy (NACTA) Programs are a partnership between Netball ACT, the

ACT Government through the ACT Academy of Sport (ACTAS) and Netball Australia. A number

of programs are delivered as part of the Academy with varying levels of involvement from the

three stakeholders, the ACTAS/NACTA structure is as follows:

The ACTAS/NACTA Programs are conducted as part of the Netball Australia national high

performance pathway. The components are delivered as an ACTAS Scholarship Program which is

an integral member of the National Institute Network (NIN) that supports the Netball Australia

High Performance Unit to deliver its national objectives. The Netball Australia and Netball ACT

objectives achieved through these programs are as follows:

Netball Australia Netball ACT

To deliver a world class netball program that prepares athletes and teams to win milestone events.

To provide a comprehensive athlete pathway that is consistent with the national framework

To identify and develop the next generation of pre‐elite athletes for sustained international success

Provide talent identification opportunities for athletes within the ACT

To build and maintain effective relationships with key stakeholders to deliver the National High Performance Plan

Establish a daily training environment that complements the athlete pathway

Gold •ACTAS/NACTA Gold

•Developing International Athlete

•Nationally identified athlete with the potential to progress to World CLass and/or International Class Athlete status within 1 – 3 years

•Delivered as an ACTAS Scholarship Program

Black •NACTA Black

•Potential International Athlete

•Nationally identified athlete with the potential to progress to the Australian 19/U squad/team within 1 – 3 years and Developing International Athlete status within 4 – 7 years

•Delivered as an NACTA Scholarship Program

Pink •NACTA Pink

•Potential International Athlete

•Nationally identified athlete with the potential to progress to the Australian 17/U squad/invitees within 1 – 3 years and Developing International Athlete status within 4 – 7 years

•Delivered by Netball ACT utilising ACTAS Strength and Conditioning services

DaD •Develop a Diamond

•Emerging Potential Athlete

•State/Territory identified and Nationally endorsed athletes with the ability to progress to Potential International Athlete status within 1-3 years

•Delivered by Netball ACT in accordance with Netball Australia 's Develop a Diamond Acadmey Program sylabus

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ACTAS Vision - The leading environment to enhance talented ACT athletes

ACTAS Purpose - To contribute to Australia’s Winning Edge elite sport objectives by providing a

quality daily training environment that enhances athletic development through providing quality

high performance programs and services that recognise individuals’ athletic needs and facilitate

growth and excellence.

2. SELECTION PHILOSOPHY

The ACTAS/NACTA Programs provide a daily training environment that supports the athlete

pathway and are important and relevant in developing successful athletes. Netball ACT is

committed to selecting athletes whose current performance indicates physical, tactical and

mental potential to progress through the athlete pathway and develop as an elite netballer.

The ACTAS/NACTA athletes will be selected with the following overriding objectives: i. To provide a pathway for ACT athletes who wish to compete for Australia

ii. To identify and prepare athletes for the transition into national elite programs

iii. To train and compete with a high performance culture

3. ELIGIBILITY CRITERIA

3.1. Athletes seeking selection to an ACTAS/NACTA Program must meet the following criteria:

i. Must be a member of Netball ACT or qualify to compete for the ACT at the National

Championships and/or the Australian Netball League under the Birth Right Policy of

Netball Australia

ii. Must meet Netball Australia’s eligibility criteria for the National Championships and/or

the Australian Netball League

iii. Must be in good standing with their District and Netball ACT including no monies

owing or no disciplinary action currently being pursued against them

iv. Must compete in the Netball ACT State League or Junior Championships

v. Must attend all activities identified in the Selection Requirements

a) Where an athlete is unable to attend an activity identified in the Selection

Requirements because of injury or extraordinary circumstances they can seek an

exemption if they meet the requirements outlined in the Appendix 5 - Exemption

Process.

vi. Must be of a physical and mental health and fitness standard consistent of a high

performance athlete

3.2. Additional ACTAS Selection Criteria

i. Capacity for ACTAS to ‘make a difference’ to the athlete’s ongoing development.

ii. Capacity and willingness of the athlete to utilise ACTAS services to enhance their

athletic development.

iii. Other important criteria against which an application may be assessed include:

a) The athlete’s performance and results in previous year. (This can also include

Coachability, off court behaviour, disciplinary matters, attendance at school if

school age etc.)

b) Current / former ACTAS scholarship athlete’s usage of ACTAS services and

commitment to developing as an elite athlete including their willingness to take

direction from ACTAS performance service staff and their coach/es.

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c) Communication with ACTAS staff will also be accessed.

d) An Athlete interview – potential scholarship holders may be requested to present

their case for selection to the selection committee

4. SELECTION PANEL

The Selection Panel will be responsible for selecting the best possible squad to achieve the

stated outcomes while maintaining the integrity of this selection policy. The Selection Panel will

consist of the Coaching Technical Advisory Group (C-TAG) and will be responsible for making

recommendations to the Joint Management Committee (JMC) which comprises of the key

program partners and will be represented by the signatories from Netball ACT, ACTAS and

Netball Australia.

All members of the Selection Panel must declare any real or perceived conflicts of interest to the

General Manager of Netball ACT; it is the responsibility of the General Manager to determine if a

conflict of interest could affect the outcome of the selection process and if so, replace the

member of the Selection Panel. In the event that one or more of these individuals is unavailable

to fulfil the role of selector for any reason, the General Manager will appoint a suitably qualified

replacement.

The Selection Panel will have the scope to encourage athletes to nominate for an ACTAS/NACTA

Program. In encouraging athlete nominations, it must be clear that this does not constitute pre-

selection and the athlete will still be required to fulfil the selection criteria.

5. SELECTION CRITERIA

Athletes seeking inclusion in an ACTAS/NACTA Program must fulfil the selection requirements

outlined in Appendix 1.

Nominating athlete will be assessed by the Selection Panel based on their performances at the

following events and/or activities:

National Netball Championships and/or Australian Netball League

Netball ACT State Selection Trials

ACT Schoolgirls Selection Trials

CCC ACT State League

ACT Junior Netball Championships

Participation in previous NACTA Programs

Nominating Athletes will be assessed on the key performance areas as identified in the Netball

Australia’s National Athlete Pathway. The skills that will be assessed by the Selection Panel for

each program are provided in Appendix 2. .

6. SQUAD FORMATION

Netball ACT’s C-TAG will make recommendations to the JMC. Where required, a representative

of C-TAG may present their recommendations to the JMC to outline the rationale behind the

recommendations. The selected athletes must be approved by the JMC prior to scholarships

being offered.

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Athletes will be notified of their selection/non-selection via the Netball ACT website with the

final squad to be posted at a specified date and time as identified in the Appendix 3 – Key Dates.

Non-selected athletes will be provided feedback upon request.

7. KEY DATES

The key dates for the establishment and delivery of the ACTAS/NACTA Programs are provided in

Appendix 3.

8. APPEALS PROCESS

A nominating athlete that has not been selected to an ACTAS/NACTA Program has the right to

appeal the decision in accordance with the By Law 05/06 – Appeals. The key points of the

appeals process are as follows:

i. Appeals must be lodge with Netball ACT within 14 days of the decision being notified

to the athlete

ii. A fee of $100 must be paid at the time of lodging the notice of the appeal

a) The fee will be refunded if the appeal is upheld

b) The fee will be forfeited in the appeal is dismissed

iii. Neither party shall be entitled to legal representation at the hearing of the appeals

panel

iv. If the appeal is upheld, Netball ACT has 14 days from the time the recommendation is

forwarded to the President to consider appropriate action

9. POWER TO AMEND

This policy can be amended at any time by the Board of Netball ACT if the Board is of the opinion

that such an amendment is necessary as a result of any change in the Netball Australia

guidelines, to give effect to the policy following discovery of a drafting error or oversight or for

any other reason determined to be in the best interests of Netball ACT. Netball ACT shall not be

responsible or liable in any way to anyone as a result of any such amendment.

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APPENDIX 1 – 2015 SELECTION REQUIREMENTS

Athletes seeking selection to an ACTAS/NACTA Program are required to:

i. Complete a ACTAS/NACTA Nomination form (Appendix 4)

ii. Currently or previously participated in at least one of the following events and/or

activities:

a) Australian Netball League

b) ACT State Selections

c) National Netball Championships

d) ACT Schoolgirls Selection Trials

e) CCC ACT State League

f) ACT Junior Netball Championships

g) Participation in a previous NACTA Program

iii. Commit to all program activities including but not limited to:

a) Any group or individual court session

b) Any strength and condition session

c) Any athlete welfare/education sessions

iv. Be available for public appearances, school clinics and holiday programs where

appropriate and as agreed between Netball ACT the individual athletes

v. Meet the athlete financial contribution of the program

a) ACTAS/NACTA Gold $250.00

b) NACTA Black $250.00

c) NACTA Pink $175.00

Athletes who are unable to meet any aspect of the selection requirements must notify Netball ACT

when nominating or as soon as practically possible.

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APPENDIX 2 – PROGRAM SELECTION CRITERIA

SELECTION CRITERIA – NACTA PINK

Movement Skills

Take-Off

o Demonstrate efficient technique from a stationary and moving start

Straight movement forward and backward

Diagonal movement to the left and right

Footwork

o Demonstrate efficient running technique

o Able to sprint and change direction

o Side step

o Speed of footwork

o Recovery footwork

o Working a number of combinations

Jumping

o Demonstrate efficient technique

Able to jump off left or right foot

Able to jump from both feet simultaneously

Able to turn in the air

Landing

o Demonstrate safe and balanced technique

Able to land on left or right foot

Able to land on both feet simultaneously

Able to pivot in all directions with outside turn

Ball Skills

Catching

o Demonstrate correct technique and accurate execution

Strong catch and snatch

Two hands

One hand control – both hands

Throwing

o Demonstrate correct technique and accurate execution

Introduce use of the ball on either side of the body

Shoulder pass

Dominant hand

Non-dominant hand

Chest pass

Bounce pass

Lob pass

Two hand overhead pass

Introduce the fake pass

o Variation on timing of release of pass

o Placement of pass

o Using a variety of options under pressure

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Attacking Skills

Straight leads

Diagonal leads

Dodge

Double dodge

Change of Direction

Front cut

Holds

Lunges

Two leads

Creating Space

o Clearing leads

o Clearing leads and drives

o Clearing leads and re-offers

Half roll and full roll

Change of pace

Screens

Vision

Decision Making

Space Awareness

Communication skills

Defending Skills

Defensive footwork

o Shadowing

Body control and re-positioning

o Recovery step

One on one defending

o Front position

o Side position

o Back position

Two on one defending

Adjusting body position as ball approaches

Intercepting

o Attack on the first ball

Hands over the ball

Delay and deny space

Sagging

Communication skills

Working together in and out of circle

Split circle

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Shooting

Demonstrate correct and accurate technique

o Stationary

Short

Medium

Long

o Step forward

o Step back

o Side step

Screens

Rebounding

Working together in and out of the circle

Work rate and shot

Communication skills

Strategies

Centre Pass – Attack

o Simple set up positions

One on one

Two on one

o Delivery of centre pass

Centre Pass – Defence

o One on one

o Two on one

o Working as a unit

o Communication skills

Base Line Throw-in – Attack

o Simple back line throw-ins

o Ability to read the play

Vision

Space Awareness

Decision Making

Base Line Throw-in – Defence

o One on one

o Two on one

o Communication

o Working as a unit

Shooting Circle – Attack

o Demonstrate the ability to apply and understand unit skills

Shooter/Goal Attack leads

Exploring variations of rotations in the circle

Holds

Screens

Shooter to shooter passes

Rebounding

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Shooting Circle – Defence

o One on one

o Two on one

o Split circle

o Communication skills

o Change of body position as ball approaches

o Defence of shot

Lean

Jump

Box out

o Rebound

o Outlet pass

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SELECTION CRITERIA – ACTAS/NACTA BLACK

Skills in italics are in addition to the NACTA Pink criteria.

Movement Skills

Take-Off

o Demonstrate efficient technique from a stationary and moving start

Straight movement forward and backward

Diagonal movement to the left and right

Footwork

o Demonstrate efficient running technique

o Able to sprint and change direction

o Side step

o Speed of footwork

o Recovery footwork

o Working a number of combinations

Jumping

o Demonstrate efficient technique

Able to jump off left or right foot

Able to jump from both feet simultaneously

Able to turn in the air

Landing

o Demonstrate safe and balanced technique

Able to land on left or right foot

Able to land on both feet simultaneously

Able to pivot in all directions with outside turn

Safe technique after a sprint

Ball Skills

Catching

o Demonstrate correct technique and accurate execution

Strong catch and snatch

Two hands

One hand control – both hands

Able to catch a high and low ball one hand

Hooking ball into catch with either right or left hand

Throwing

o Demonstrate correct technique and accurate execution

Able to throw from either side of the body

Shoulder pass

Chest pass

Hip Pass

Bounce pass

Lob pass

Two hand overhead pass

Fake pass

Step around to pass

o Variation on timing of release of pass

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o Placement of pass

o Using a variety of options under pressure

Attacking Skills

Straight leads

Diagonal leads

Dodge

Double dodge

Change of Direction

Front cut

Back cut

Holds

Lunges

Drive, stop and lunge back

Change of pace

Double play

Up and back

o Straight

o Diagonal

Two Leads

Creating Space

o Clearing leads

o Clearing leads and drives

o Clearing leads and re-offers

Half roll and full roll

Screens

Vision

Decision Making

Space Awareness

Communication skills

Defending Skills

Defensive footwork

o Shadowing

Body control and re-positioning

o Recovery step

One on one defending

o Front position

o Side position

o Back position

Two on one defending

Adjusting body position as ball approaches

Intercepting

o Attack on the first ball

Hands over the ball

o Adjusting body position to force ball wide

Delay and deny space

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Sagging

Communication skills

Working together in and out of circle

Split circle

Shooting

Demonstrate correct and accurate technique

o Stationary

Short

Medium

Long

o Step forward

o Step back

o Side step

o Jump shot

o Shuffle Shot

Variation on timing on release of shot

Screens

Rebounding

Working together in and out of the circle

Work rate and shot

Communication skills

Strategies

Centre Pass – Attack

o Greater variety on initial set up

One on one

Two on one

Screens

o Delivery of centre pass

Centre Pass – Defence

o One on one

o Two on one

o Working as a unit

o Communication skills

o Wall

o Forcing the attack wide

Base Line Throw-in – Attack

o Greater variety in start positions and movement

o Ability to read the play

Vision

Space Awareness

Decision Making

Base Line Throw-in – Defence

o One on one

o Two on one

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o Dictating space

o Area/Zone

o Communication

o Working as a unit

Shooting Circle – Attack

o Demonstrate the ability to apply and understand unit skills

Shooter/Goal Attack leads

Exploring variations of rotations in the circle

Holds

Shooter to shooter passes

Screens

Shooting Circle – Defence

o One on one

o Two on one

o Split circle

o Area/Zone defence

o Communication

o Change of body position as ball approaches

o Defence of shot

Lean

Same arm and leg

Opposite arm and leg

Two arms and both feet

Jump

Same arm and leg

Opposite arm and leg

Two arms and both feet

Crouch

From a lean to a jump

Box out

o Rebound

o Outlet pass

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SELECTION CRITERIA – ACTAS/NACTA GOLD

Skills in italics are in addition to the ACTAS/NACTA BLACK criteria.

Movement Skills

Take-Off

o Demonstrate efficient technique from a stationary and moving start

Straight movement forward and backward

Diagonal movement to the left and right

Footwork

o Demonstrate efficient running technique

o Able to sprint and change direction

o Side step

o Speed of footwork

o Recovery footwork

o Working a number of combinations

o Turning from a sprint movement

Jumping

o Demonstrate efficient technique

Able to jump off left or right foot

Able to jump from both feet simultaneously

Able to turn in the air

Landing

o Demonstrate safe and balanced technique

Able to land on left or right foot

Able to land on both feet simultaneously

Able to pivot in all directions with outside turn

Safe technique after a sprint

Ball Skills

Catching

o Demonstrate correct technique and accurate execution

Strong catch and snatch

Two hands

One hand control – both hands

Able to catch a high and low ball one hand

Hooking ball into catch with either right or left hand

Throwing

o Demonstrate correct technique and accurate execution

Able to throw from either side of the body

Shoulder pass

Chest pass

Hip Pass

Bounce pass

Lob pass

Two hand overhead pass

Fake pass

Step around to pass

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o Variation on timing of release of pass

o Placement of pass

o Using a variety of options under pressure

Attacking Skills

Straight leads

Diagonal leads

Dodge

Double dodge

Change of Direction

Front cut

Back cut

Holds

Lunges

Drive, stop and lunge back

Change of pace

Double play

Up and back

o Straight

o Diagonal

Two Leads

Creating Space

o Clearing leads

o Clearing leads and drives

o Clearing leads and re-offers

Half roll and full roll

Screens

Vision

Decision Making

Space Awareness

Communication skills

Defending Skills

Defensive footwork

o Shadowing

Body control and re-positioning

o Recovery step

One on one defending

o Front position

o Side position

o Back position

Two on one defending

Adjusting body position as ball approaches

Intercepting

o Attack on the first ball

Hands over the ball

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o Adjusting body position to force ball wide

Delay and deny space

Sagging

Communication skills

Working together in and out of circle

Split circle

Shooting

Demonstrate correct and accurate technique

o Stationary

Short

Medium

Long

o Step forward

o Step back

o Side step

o Jump shot

o Shuffle Shot

Variation on timing on release of shot

Screens

Rebounding

Working together in and out of the circle

Work rate and shot

Communication skills

Strategies

Centre Pass – Attack

o Greater variety on initial set up exploring all options

One on one

Two on one

Screens

o Accurate and consistent delivery of centre pass

Centre Pass – Defence

o One on one

o Two on one

o Working as a unit

o Communication skills

o Wall

o Forcing the attack wide

o Keeping attackers off the circle edge

Base Line Throw-in – Attack

o Greater variety in start positions and movement

o Ability to read the play

Vision

Space Awareness

Decision Making

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Base Line Throw-in – Defence

o One on one

o Two on one

o Dictating and restricting space

o Area/Zone

o Communication

o Working as a unit

Shooting Circle – Attack

o Demonstrate the ability to apply and understand unit skills

Shooter/Goal Attack leads

Exploring variations of rotations in the circle

Holds

Shooter to shooter passes

Screens

Shooting Circle – Defence

o One on one

o Two on one

o Split circle

o Area/Zone defence

o Communication

o Working together as a unit

o Change of body position as ball approaches

o Defence of shot

Lean

Same arm and leg

Opposite arm and leg

Two arms and both feet

Jump

Same arm and leg

Opposite arm and leg

Two arms and both feet

Crouch

From a lean to a jump

o Box out

o Rebound

o Outlet pass

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APPENDIX 3 – 2015 KEY DATES

The key dates for the 2015 ACTAS/NACTA Programs are as follows:

ACTAS/NACTA Programs

Athlete nominations open 08 May 2015

Athlete nominations close 18 May 2015

ACTAS pre scholarship process 25 May 2015

Athlete Screenings and Induction Week beginning 01 June 2015

ACTAS/NACTA Squad Announcements 01 June 2015

Program Starts Week beginning 01 June 2015

Program Concludes 31 May 2016

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APPENDIX 4 – NOMINATION FORM

ACTAS/NACTA PROGRAMS

2015 ATHLETE NOMINATION FORM

Nominations are being sought for athletes wishing to be considered for the 2015 ACTAS/NACTA Programs.

Athlete selections will be conducted in accordance with the ACTAS/NACTA Programs Selection Policy.

Nominating athletes are required to complete the following nomination form and return to Netball ACT before

the close of nominations, late nominations will not be accepted.

1. PERSONAL DETAILS

Name and Surname

Address Street or PO

Suburb Postcode

Contact Details Home Ph.

Mobile

Email

Date of Birth

Height

2. NEXT OF KIN

Name

Relationship

Emergency Contact No. Mobile

Email

Southwell Park, Northbourne Ave

Lyneham ACT 2602

PO Box 423

Dickson ACT 2602

Tel: 02 6241 4088

Fax: 02 6241 2434

www.act.netball.asn.au

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3. NETBALL DETAILS

District

Club

District Coach

Coach Contact No. Mobile

Preferred Playing Position

Highest Level Playing in 2015

4. IMPORTANT INFORMATION

All nominating athletes must fulfil the selection requirements identified in the Selection Requirements section

of the ACTAS/NACTA Programs Selection policy.

The dates for selection are identified in the Key Dates section of the ACTAS/NACTA Programs Selection Policy.

An athlete financial contribution will be charged for participation in the 2015 Academy Program, athletes will

be notified of this amount at selections.

Nominations close by close of business Monday, 18 May 2015 and are to be returned by post, email or fax to:

Kim Clarke, Programs Administrator

PO Box 423

Dickson ACT 2602

Email: [email protected]

Fax: 02 6241 2434

5. Declaration

I hereby nominate for consideration in the 2015 ACTAS/NACTA Program and I accept the above conditions and

agree to be bound by the selection law and directions of the Board of Netball ACT, ACTAS and Netball Australia

(Parent/Guardian signature required for players under the age of 18)

Name

Parent or Guardian

Sign Sign

Date Date

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APPENDIX 5 – APPLICATION FOR EXEMPTION

2015 ACTAS/NACTA PROGRAMS

APPLICATION FOR EXEMPTION

The following form is to be completed by nominating athletes wishing to apply for an exemption from a

selection, training or competition commitment with the ACTAS/NACTA Program. The form must be completed

in whole and supporting documentation must be provided where appropriate. Where required, please attach

an additional page to support your application.

Name and Surname

Address Street or PO

Suburb Postcode

Contact Details Home Ph.

Mobile

Email

I am applying for the following exemption (please complete the corresponding section):

Injury or illness Employment or education Bereavement Other

Sessions Missed: Selection From: To:

Training From: To:

Competition From: To:

Injury or illness

Nature of Report: Illness Injury

Diagnosis:

Type of Injury: New Old / Recurrent

Cause of Injury: Competition Training Cross Training

Other (specify):

Status: Modified Training / Competition No Training / Competition

Southwell Park, Northbourne Ave

Lyneham ACT 2602

PO Box 423

Dickson ACT 2602

Tel: 02 6241 4088

Fax: 02 6241 2434

www.act.netball.asn.au

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Expected Return Date:

Medical Certificate Provided: Yes No

Employment or Education

Employer/Institution:

Status: Full-time Part-time Casual

Please provide the circumstances resulting in the required absences:

Supporting documentation provided: Yes No

Bereavement

Please provide the circumstances resulting in the required absences:

Supporting documentation provided: Yes No

Other

Please provide the circumstances resulting in the required absences:

Supporting documentation provided: Yes No

Declaration

I, ______________________________ declare that the information provided is true and correct and

acknowledge that any misleading information may result in me being ineligible for selection.

Signed: ____________________________________ Date: ___________________________