CANADIAN RUGBY FOUNDATION
MEN’S HIGH PERFORMANCE RUGBY
FINANCIAL ASSISTANCE AWARD
APPLICATION FORM

Applicant information:
Surname:	                    First Name:	                                Middle Name or Initial:	
Provincial or national team selection:                              Year(s)
1. 
2. 
3. 
4.	
Financial Needs Letter Attached: 	□ Yes	
	
Date of birth (dd/mm/yyyy):	
Permanent address:
Street:	City/Town:
Province/Territory:	Postal Code:	
Primary Telephone Number:	
E-Mail Address:	

Career goals:	
Rugby goals and plans:

	
How will this award help you achieve these goals?

	
I certify that the above information is accurate and I understand that any false or incomplete information may invalidate my eligibility. I accept that award decisions may only be made by the Canadian Rugby Foundation. 

	
Signature of Applicant	Date	
If successful, you will be asked to provide:

1.	a void cheque or to complete a Direct Deposit Form so funds can be transferred electronically (by EFT)
2.	your Social Insurance Number (for tax purposes as this award is treated as taxable income)
3.	an agreement to publicly release my name and photo

THIS APPLICATION FORM APPLIES TO AWARDS MANAGED BY THE MEN’S HIGH PERFORMANCE FINANCIAL ASSISTANCE FUND BOARD OF TRUSTEES