Aviva Club of the Month

  1. Aviva Club of the Month 2012/2013 Nomination Form

  2. Club Name(*)
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  3. Affiliated League 1
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  4. Affiliated League 2
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  5. Affiliated League 3
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  6. Club Address
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  7. Club Secretary
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  8. Club Secretary Phone
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  9. Club Secretary Email(*)
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  10. Club Formed Year
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  11. Club Objective or Mission
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  12. Administration

  13. Please list your Committee Members
  14. Chairman
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  15. Vice Chairman
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  16. League Secretary
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  17. PRO
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  18. Treasurer
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  19. Children Officer
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  20. Volunteer Coordinator
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  21. Others please list
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  22. Constitution
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    File size must be less than 2MB to submit successfully. It is recommended to send files in PDF/DOC/XLS format.
  23. Newsletter
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    File size must be less than 2MB to submit successfully. It is recommended to send files in PDF/DOC/XLS format.
  24. Website URL
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  25. Main sponsor
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  26. Grant Applications
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  27. If yes enter details
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  28. Have you attended any volunteer workshops in:
  29. Volunteer Management
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  30. Fundraising
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  31. Groundskeeping
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  32. Coaching

  33. Number of coaches in your club
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  34. Enclose list of qualified coaches names and levels achieved
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    File size must be less than 2MB to submit successfully. It is recommended to send files in PDF/DOC/XLS format.
  35. Name of Coaching Coordinator(if you have any)
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  36. Coaches involved in Emerging Talent Programme. List names.
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  37. Participation

  38. No. of girls/womens teams
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  39. No. of boys teams
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  40. No. of adults teams
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  41. No. of players from Minority,Ethnic and Cultural Backgrounds
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  42. No. of players in the Football For All Programme
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  43. Is your Club involved in...
  44. Futsal
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  45. Summer Soccer Schools
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  46. Soccer Sisters
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  47. Facilities

  48. No. of pitches you own
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  49. No. of pitches you rent
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  50. No. of all weather pitches you own
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  51. No. of indoor pitches you own
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  52. Please list Club House Facilities if applicable
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  53. Future Development Plans
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  54. Performance

    (in the 3 last years)
  55. Number of Leagues won by...
  56. Boys
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  57. Girls
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  58. Men
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  59. Women
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  60. Number of Cups won by...
  61. Boys
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  62. Girls
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  63. Men
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  64. Women
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  65. Number of National Leagues won by...
  66. Boys
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  67. Girls
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  68. Men
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  69. Women
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  70. Number of players in League Representative Squads
  71. Boys
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  72. Girls
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  73. Men
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  74. Women
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  75. Number of players in International Teams
  76. Boys
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  77. Girls
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  78. Men
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  79. Women
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  80. Number of Players in Emerging Talent Programme
  81. Boys
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  82. Girls
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  83. Good Practice

  84. Does your club have Code of Ethics Training
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  85. If yes(who/when)
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  86. Does your Club have a Child Protection Officer
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  87. If Yes(Names)
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  88. Club Policies/Procedures
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    File size must be less than 2MB to submit successfully. It is recommended to send files in PDF/DOC/XLS format.
  89. Do you have any referees
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  90. If you have referees list names and levels achieved
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  91. Contribution to the Community

  92. Does your Club Share/Loan Facilities to:
  93. Local Schools
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  94. Youth Clubs
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  95. Football For All Groups
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  96. Is your Club involved in Community Fundraising/Celebrations
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  97. If yes please give details
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  98. Does your Club have links with Local Authorities/Communities
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  99. If yes please give details
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  100. Does your Club have Blitz/Fun days
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  101. If yes please give details
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  102. Any other Contribution to the Community
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  103. Review & Submit

  104. Please tell us in no more than 100 words why your club should win Aviva Club of the Month
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  105. (*) = Required Field. Please ensure that all attachments fit the required specifications. Also if the form process is unsuccessful due to an "invalid Input" please correct the appropriate field and ensure that all attachments are still selected for submission.
  106. Submit your Nomination

  107. Once you click submit it may take a few minutes to upload the selected files. If this happens do not leave this page or hit the back button as your submission will be lost.

    If you have any problems submitting this form, please fill out the attached document here and email to avivacotm@fai.ie