Welcome to your #DiscoverYour Para Potential application form...
It is important that you complete the entire application as fully and accurately as you can so that our team of coaches and sport scientists can fully consider your application.  Therefore please allow yourself enough time to complete the form, it should take no more than 20 minutes.

Questions marked with an asterisk (*) are required and you will not be able to submit your application if an answer is not provided.

You will be required to complete your application in one go, as there is no save function.  We require you to upload a full body photo of yourself in appropriate sports kit.  Please ensure we can see you from head to toe and that you have any impairment specific equipment on e.g. a running prosthetic. Where possible please can you take your picture in front of a door as this provides a reference for height.
Let's get started
 
Before embarking on your application we need you to confirm that you understand how your data might be used.  Below are two statements, please read carefully and then tick if you agree

 
I understand and agree that the information collected may be made available as considered necessary to National Governing Bodies, the English Institute of Sport and UK Sport *

     
 
I understand and agree that the information will be stored for a period of 8 years and that my anonymised data may be used for research and publication purposes *

     
 
In the first section we need to gather some basic personal details, please take your time to ensure they are correct as this will be our main method of contacting you.

 
First Name *

What is your first name?
 
Surname *

Okay {{answer_51383847}}, now we need to know your surname.
 
Address

We would like to know where you live as we may need to send you important information about #DiscoverYour Gold
 
Address Line 1 *

 
Address Line 2

 
Town or City *

 
County *

 
Post Code *

 
Date of Birth *

{{answer_51383847}}, when were you born?
 
British Passport *

Do you hold a valid British Passport?
     
 
Residence in the UK

Okay {{answer_51383847}}, you have indicated you do not hold a valid British passport, please can you tell us how many years you have lived in the UK for?
 
Nationality

As you don't hold a British Passport, we also need to know what your nationality is.
 
Phone Number *

What is the best phone number to contact you on?  Were possible please provide a mobile phone number.
 
Height *

We need to know how tall you are, please provide your height to the nearest centimetre (cm)
 
Weight *

Can you tell us how much you weigh, make sure you provide your weight to the nearest kilogram (kg)
 
Photo *

Thanks for those details  {{answer_51383847}}, we have one last question in this section.  We require you to upload a full body photo of yourself in appropriate sports kit.  Please ensure we can see you from head to toe and that you have any impairment specific equipment on e.g. a running prosthetic.

Where possible please can you take your picture in front of a door as this provides a reference for height.
 
Thanks {{answer_51383847}} for filling your personal details out, in this next section we would like to know as much as possible about your impairment.

 
Your Primary Impairment

 
Your Impairment *

Firstly, please provide a brief description of your impairment. For example, the name and/or medical diagnosis of your impairment.
 
Day to day and Sporting Life *

Now we would like to know how your impairment affects you on a day to day basis and when you take part in sport
 
Impairment Group *

Chose the impairment groups that are relevant to you within the below list.  If you don't know please chose "I am not sure".

 
Impairment Status *

Is your impairment stable or progressive?

 
Timing of Diagnosis *

Have you had your impairment from birth (congenital) or did you acquire your impairment due to illness or injury?

 
When did your acquired injury occur? *

As you have an acquired impairment we would like to know in what year it occurred. Please provide the full year for example 2012
 
Area of body affected *

We also need to know what areas of the body are affected by your impairment, please chose from the list below

 
Medical Diagnosis *

Do you have a confirmed diagnosis and supporting medical evidence for your impairment.  This is essential information if you are successful and need to be classified in your sport.
     
 
Do you have a secondary impairment? *

     
 
Secondary Impairment

 
Your Impairment *

Please provide a brief description of your secondary impairment. For example, the name and/or medical diagnosis of your impairment.
 
Day to day and Sporting Life *

Now we would like to know how your secondary impairment affects you on a day to day basis and when you take part in sport
 
Impairment Group *

Chose the impairment groups that are relevant to you within the below list.  If you don't know please chose "I am not sure".

 
Impairment Status *

Is your impairment stable or progressive?

 
Timing of Diagnosis *

Have you had your impairment from birth (congenital) or did you acquire your impairment due to illness or injury?

 
When did your acquired injury occur? *

As you have an acquired impairment we would like to know in what year it occurred. Please provide the full year for example 2012
 
Area of body affected *

We also need to know what areas of the body are affected by your impairment, please chose from the list below

 
Medical Diagnosis *

Do you have a confirmed diagnosis and supporting medical evidence for your impairment.  This is essential information if you are successful and need to be classified in your sport.
     
 
Locomotion *

The last question about your impairment is about how you get around every day, from the list below please chose your main method of getting about.

 
Now is your chance to tell about your sporting history. We will first ask about any disability sport you take part in, you will then have the opportunity to tell us about any able body sport you may have taken part in.

 
Do you take part in disability sport? *

     
 
Disability Sport

 
Disability Sport *

What is your main disability sport?
 
Disability Sport - Main Event or Position

When participating in {{answer_51389793}} what was the main event your competed in, or if you played a team sport what was your position?
 
Disability Sport - Classification

If you have ever been formally classified for {{answer_51389793}}, please provide details of your classification?
 
Disability Sport - Additional Sport history

Please use the box below to highlight any additional information about your disability sporting history.

For example other sports you play, further information about your training or competition in your main sport.
 
Did you play able body sport?

     
 
Able Body Sport

 
Able Body Sport *

What was main the able body sport you played?
 
Able Body Sport - Main event or position *

When participating in {{answer_51389096}} what was the main event your competed in, or if you played a team sport what was your position?
 
Able Body Sport - Additional Sport history

Please use the box below to highlight any additional information about your sporting history.

For example other sports you play, further information about your training or competition in your main sport.
 
Cycling *

Can you ride a bike?
     
 
Swimming *

Can you swim?
     
 
In this section we would just like to know any basic medical information we may need to be aware of when inviting you to an assessment event.

 
Basic Medical Information

Do you suffer from any of the following?

 
Family History *

Has anyone in your immediate family died under the age of 55 from a heart or circulation disorder?
     
 
Additional Medical Information

Please provide any additional medical information you feel may be appropriate for us to know.
 
Eye Wear

 
Do you wear glasses or contact lenses? *

     
 
Can you read the top line of a sight chart whilst wearing your glasses/contact lenses?

     
 
You are nearly there, in the last section we just want to find out some additional information about yourself and your motivations for signing up to #DiscoverYour Para Potential

 
How did you hear about #DiscoverYour Para Potential *


 
Your Motivation *

Which of the following reasons would you describe as your biggest motivation for signing up to #DiscoverYour Para Potential

 
Sports you're interested in

We would like to know if there any sports that you have a particular interest in being tested for, please list these below.  We will assess your suitability for these sports and other sports based on your application.
 
Additional info

{{answer_51383847}}, this is the last question, and it is your opportunity to share any more facts about yourself that you think may be valuable to us.
Thank you {{answer_51383847}} for completing your application for #DiscoverYour Para Potential.  

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