Inclusive Clubs Project 2020-21

Expression of Interest Form

This form collects some information about your club and your commitment to becoming more inclusive. Please answer all the questions as best you can and provide examples where possible.

Question Title

* 1. Tell us about you and your club

Your Club Name

Your Name (person completing EOI)

Your Position at the Club

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* 2. Tell us about your club members, players, committee and officials. If you don't have data available, please leave it blank.

Total Club Members (Male and Female)

Adult Playing Members (Male and Female)

Junior Playing Members (Male and Female)

Club Committee (Male and Female)

Coaches (Male and Female)

Support roles - team managers, referees, judges, scorers, runners, umpires, canteen etc (Male and Female)

Volunteers not represented above (Male and Female)

Paid Staff (Male and Female)

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* 3. Fill in the boxes below to help us understand what would your club like to get out of being involved in the Inclusive Clubs Project?

Things we do well are:

Changes we would like to make to be more inclusive are:

Areas where we need to learn more about inclusion are:

Two representatives of your club need to attend each workshop. Please provide the details of at least two club members below, who will represent your club at the workshops

Question Title

* 4. Club Member #1 (Key Contact)

Name

Position/role in club

Gender

Contact phone number

Contact email address

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* 5. Club Member #2

Name

Position/role in club

Gender

Contact phone number

Contact email address

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* 6. Club Member #3

Name

Position/role in club

Gender

Contact phone number

Contact email address

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* 7. Club Member #4

Name

Position/role in club

Gender

Contact phone number

Contact email address

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* 8. How committed is your club to the Inclusive Clubs Project?

	Please choose one option
We will discuss the training sessions at all club committee meetings between January and June 2020	We will discuss the training sessions at all club committee meetings between January and June 2020 Please choose one option menu
The club committee has discussed the project and approved participation	The club committee has discussed the project and approved participation Please choose one option menu
We commit to working the Access Health and Community and Leisure Networks to write an Inclusion Plan for our club	We commit to working the Access Health and Community and Leisure Networks to write an Inclusion Plan for our club Please choose one option menu
We commit to performing a inclusion assessment of our club with Access Health and Community	We commit to performing a inclusion assessment of our club with Access Health and Community Please choose one option menu
We will ensure two club representatives attend each of the six training sessions	We will ensure two club representatives attend each of the six training sessions Please choose one option menu