T E A M T E A M I T U 2 0 1 7 – I T U D E V E L O P M E N T P R O J E C T

National Federation

NF Contact

E-mail :

Name /detai ls of proposed athlete

Family name: F irs t Name:

Date of Bir th: dd mm yyyy Gender: Male Female

E-mai l :

Head Coach of proposed athlete

Family name: F irs t Name:

E-mai l :

TEAM ITU - Event being Appl ied for (mark yes/no) 2017 Chengdu ITU Triathlon World Cupdate : 6 - 7 Ma y, f ormat : semi -fi na l s - fina ls

Yes No

2017 Madrid ITU Triathlon World Cupdate : 2 7 -2 8 May, f or mat : sp r i nt d is tance

Yes No

2017 Tiszaujvaros ITU Triathlon World Cupdate : 2 2 -2 3 Ju ly , fo rmat : semi -fi na l s - fin a ls

Yes No

2017 Salinas ITU Triathlon World Cup * date : 2 8 -2 9 Oct ober , f or mat : s t andar d d i s ta nce Yes No

2017 Buenos Aires ITU Triathlon World Cup * date : 4 - 5 Nov emb er , fo rmat : spr i nt d i s tanc e

2017 Tongyeong ITU Triathlon World Cup ** date : 2 8 -2 9 Oct ober , f or mat : sp r i nt d is tance Yes No2017 Miyazaki ITU Triathlon World Cup ** date : 4 - 5 Nov emb er , fo rmat : s tand ard d i s tance

ITU D ev e l opment │TEAM I TU │ E l i te At h lete D eve l opment Pr o j ec t │ 20 1 7

T E A M T E A M I T U 2 0 1 7 – I T U D E V E L O P M E N T P R O J E C T

*joint project in America / ** joint project in Asia

Athlete - background in sport*

How many years have you participated in other sports before starting tr iathlon?

Sport: Years in sport:

Sport: Years in sport:

How many years have you participated in Triathlon?

Current train ing f requency & volume Current km’s per week

Current Sessions per week

Swim

Bike

Run

Athlete - Pr imary sporting achievement* (TWO RESULTS MUST BE AT CONTINENTAL CUP EVENT IN THE LAST 12 MONTHS)

Event Result Date (yyyy) Place

* N F s c a n s u p p l e m e n t t h i s i n f o r m a ti o n w i t h t h e a t h l e t e ’ s s p o r ti n g C V i f a v a i l a b l e

Athlete - Participation in ITU and/or Continental Development Projects

Have you participated in any ITU or Continental Development Projects (scholarship, camp, Team ITU)? Yes No

If , yes… please speci fy .

Project Where? When?

ITU D ev e l opment │TEAM I TU │ E l i te At h lete D eve l opment Pr o j ec t │ 20 1 7

T E A M T E A M I T U 2 0 1 7 – I T U D E V E L O P M E N T P R O J E C T

Optional Attachments (wi l l fac i l i tate approval procedure i f submitted)

Enclosed

1. Long Term Strategic Plan of the National Federation Yes No

2. Detai led sporting curr iculum of ath lete Yes No

3. Copy of ath lete’s passport Yes No

Nomination for Coaching SupportNominated Coach:

Family name: F irs t Name:

Coach’s E-mai l :Project(s) nominated for (P lease use YES or NO in your answer) :2017 Chengdu ITU Triathlon World Cup2017 Madrid ITU Triathlon World Cup2017 Tiszaujvaros ITU Triathlon World Cup2017 Salinas ITU Triathlon World Cup * 2017 Buenos Aires ITU Triathlon World Cup * 2017 Tongyeong ITU Triathlon World Cup ** 2017 Miyazaki ITU Triathlon World Cup **

*jo in t p ro ject in Ame ric a / ** jo in t p r oject in As ia

I , the unders igned, certify that the information prov ided above is accurate.

( N a m e , F u n c ti o n a n d S i g n a t u r e ) ( D a t e )

Plea se sub mit the app l i c ati on fo rm to Z i ta C sov ely ak at z i ta@tr ia th lo n.org o n o r be fo re d ue date s .

ITU D ev e l opment │TEAM I TU │ E l i te At h lete D eve l opment Pr o j ec t │ 20 1 7

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