*1.First Name(Required.)

*2.Last Name(Required.)

*3.Gender(Required.)

Male

Female

*4.Date of Birth(Required.)

*5.Email Address(Required.)

*6.Cell Phone Number(Required.)

*7.Are you a U.S. Citizen?(Required.)

Yes

No

*8.Do you intend to live in one of the Resident Houses?(Required.)

Yes

No

9.If you answered yes to the question above (living in the houses), are you planning on having a service dog living at the house with you? If your answer is YES, please indicate what service this dog will provide.

Yes

No

If you answered yes, please tell us what service your dog will provide you.

*10.Please list your health insurance provider.(Required.)

*11.Tell us about how you got involved in the sport along with how long you have been playing.(Required.)

*12.Do you intend to be part of the resident program full-time (meaning 12 months a year minus trips home to see family as dictated for holidays and approved time off)?(Required.)

Yes

No

If different plans, please specify.

*13.Do you have a full-time, part time job, or are you going to school while being part of the resident program? Please tell us about what plans you have outside of goalball training while living in Fort Wayne.(Required.)

*14.Tell us about your experience following a strength and conditioning program.(Required.)

*15.Tell us about your experience working with a sport psychologist.(Required.)

*16.Tell us about your experience working with a sports dietitian.(Required.)

*17.Tell us about your experience working with a goalball coach.(Required.)

*18.What is your greatest strength in goalball?(Required.)

*19.What is your greatest weakness in goalball?(Required.)

*20.Tell us about your home training environment and how the resident program will positively impact your training and performance.(Required.)

*21.Why do you want to be part of the resident program in 2024?(Required.)

*22.What value do you believe you would bring to the resident program training environment?(Required.)