SPORTS AUTHORITY OF INDIA NETAJI SUBHAS SOUTHERN CENTRE , BANGALORE SPORTS PROMOTIONAL SCHEMES MONITORING CELL Trainee's Performance Cumulative Record NAME OF THE CENTRE : Name of Trainee : Discipline : ID NO : Date of Admission : Scanned latest Photo of Trainee NEW SELECTION DETAILS REGULAR DAY BOARDER Name (In Capital Letters )______________________________________ Game ___________________ Event / Playing Position : __________________ Date of Birth Sex : Male Female Parent Name: ____________________________ Permanent Residential Address : Present Residential Address : ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ _____________________________ Tel No: Tel No: Email Id: Belong to : Rural or Urban Height : ________ (in CM) Weight________ Belong to : OBC SC ST GEN EDUCATION QUALIFICATIONS : Sl. No Class School / College / University Board Year of Passing School / College Address Whether undergone training in any of the SAI scheme : Yes No If Yes, Details of Scheme & Year ______________________________________ Are you In receipt of any Scholarship from SAI / State : Yes No If Yes, Furnish Details of Scholorship & Year _________________________________ Medical Fitness :- I hereby certify that Ms/Mr.................... is physically fit to undergo the selection trials of SAI promotional scheme and has no ailments which disqualify the candidate . Name , Signature & Seal of Qualified Medical Practitioner DETAILS OF PERFORMANCE / ACHIEVEMENTS ( PREVIOUS THREE YEARS ) Sl. No Competition Name Date & Venue Age Group Event Position Time / Distance ( Attach attested certified copy of each competition ) The above information is true to the best of my knowledge and will be liable for disqualification from the scheme , if found wrong at any later date. SIGNATURE OF PARENT SIGNATURE OF TRAINEE PLACE: DATE: INSTRUCTIONS : 1. Please tick the appropriate option in the box provided. 2. All attestations on the certificates ( Residence , Competitions etc ) must be from a Gazetted Officer only. 3. Date of birth proof must be only Birth Certificate from Panchayat / Municipality / 10th Class Marks Card. 4. Fitness certificate only from a Recognized & Qualified Medical Practioner. 5. All original documents to be produced for verification at time of selections. SELECTION BOARD / COMMITTEE REPORT The application form and the documents submitted by Mr/Ms _____________________ for selection in the discipline of _______________________ have been found to be in order and the selection trials results / observations / recommendations are as follows:- TEST RESULTS :- General / Specific / Special Test Category Sl.no Name of the Test Results Remarks 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 Please give remarks about the performance of child in all the tests and also mention the test category. What are the prominent technical qualities of the sports person observed :- 1. 2. 3. Recommendation of the Committee : SELECTED NOT SELECTED SELECTION CATEGORY : IF SELECTED :- 1. LONG TERM TARGET LEVEL FIXED _________________________________ 2. TIME REQUIRED Years 3. TARGET FOR CURRENT SEASON (Level/Measurable) ____________________ Member Member Member Member Convenor BIO DATA OF THE TRAINEE 1. NAME : 2. ID No : 3. DISCIPLINE : 4. NAME OF THE PARENT : 5. SEX : Male Female 6. DATE OF BIRTH : 7. PLACE OF BIRTH : ......... 8. MOTHER TOUNGE: 9. PERMANENT RESIDENTIAL ADDRESS 10. PRESENT RESIDENTIAL ADDRESS ................ ................ ................ ............... ................ ............... Ph. No: Mobile: Ph.No Mobile: 11. BLOOD BROUP : ........ 12. RURAL / URBAN : ( R / U ) 13. NOMINEE NAME : ............. RELATION ....... ( For Insurance Purpose) 14. CATEGORY : SC ST OBC GEN 15. EDUCATIONAL QUALIFICATIONS : Sl. No Class School / College / University Board School / College Address 16. PASSPORT DETAILS : NO :......... DATE OF EXPIRY: ......PLACE OF ISSUE.... 17. FAMILY SPORTS BACKGROUND : .................. ................................... SIGNATURE PLACE: DATE: PERFORMANCE TARGETS OF Mr/Ms......... SL.NO YEAR EVENT TARGET LEVEL MEASURABLE TARGET SIGN OF COACH TESTS and CONTROL : PERIODICAL ASSESSMENTS Trainees Id No : Trainee's Event : ASSESSMENT REPORT ON GENERAL . SPECIFIC and SPECIAL CONTROL TEST TECORDS Sl. No Test No & Date of Testing 30M 400M SBJ VJ Biomotor, Technical and Tactical abilities Diagnosis / Analysis Signature of Coach 1 Test 1 Date: 2 Test 2 Date: 3 Test 3 Date: 4 Test 4 Date: 5 Test 5 Date: 6 Test6 Date: COMPETITION and PERFORMANCE FOR THE YEAR 20 - 20 Sl. No Competition Date & Venue Age group Event Position Performance Remarks Coach Signature Performance Progression Assessment : Signature of the Coach TRAINEE ATTENDANCE ( To be updated under strict supervision of Administrator ) Month Present Leave * Absent Competition Camp Remarks * Specify the reason for Leave : Signature of the Administrator TRAINEE MEDICAL DETAILS ( To be updated under strict supervision of Administrator ) Sl. No Medical Details Leave Period From To No of Days Fitness Certificate Produced * * Copy of Fitness Certificate must be enclosed Signature of the Administrator 1ST QUARTER ANALYSIS The observations on progress are as below :- 1. Performance progression : Excellent Good Stangant Deteriorated 2. The discipline , behavior and general conduct in the centre : Good Not Good 3. Interest towards training : Good Satisfactory Not Satisfactory 4. Interest towards academics / studies : Good Satisfactory Not Satisfactory Any Other specific remarks :- In case of any negative progression give the reasons : Signature of Coach Signature of Incharge 2nd QUARTER ANALYSIS The observations on progress are as below :- 1. Performance progression : Excellent Good Stangant Deteriorated 2. The discipline , behavior and general conduct in the centre : Good Not Good 3. Interest towards training : Good Satisfactory Not Satisfactory 4. Interest towards academics / studies : Good Satisfactory Not Satisfactory Any Other specific remarks :- In case of any negative progression give the reasons : Signature of Coach Signature of Incharge 3rd QUARTER ANALYSIS The observations on progress are as below :- 1. Performance progression : Excellent Good Stangant Deteriorated 2. The discipline , behavior and general conduct in the centre : Good Not Good 3. Interest towards training : Good Satisfactory Not Satisfactory 4. Interest towards academics / studies : Good Satisfactory Not Satisfactory Any Other specific remarks :- In case of any negative progression give the reasons : Signature of Coach Signature of Incharge ANNUAL ASSESSMENT The observations on progress are as below :- 1. The performance target set has been : Achieved Not Achieved 2. The discipline , behavior and general conduct in the centre : Good Not Good 3. Interest towards training : Good Satisfactory Must Improve 4. Interest towards academics / studies : Good Satisfactory Must Improve 5. Retained : Not Retained : Specify Technical reasons for retention / non retention : Signature of Coach Signature of Incharge
