Creative Opportunities Unlimited, Inc.
Team Travel Grant Application Form

CONTACT INFORMATION (please provide complete information)

State/Provincial/Country Odyssey of the Mind Association:
Contact Name (first last):   Are you the: - choose one Membership Coordinator Team Coach Team Parent School Administrator Other
Contact Email Address:  
Confirm Email Address: 
Membership Name:    Membership Number:
Address 1:
Address 2:
City:   State/Province:
Country:   Zip Code/Postal Code:
Phone Number (including Country and Area Codes): Day Night

Long Term Problem Name: - select from list - Problem 1 - Odyssey Road Rally Problem 2 - DinoStories Problem 3 - The Wonderful Muses Problem 4 - Tee Structure Problem 5 - Eccentrics   Division: - select I II III IV

Date of tournament in which team qualified for World Finals (day-month-year):

TEAM MEMBER INFORMATION

                           First Name  Last Name             Years in Odyssey      # Times at WF         Notes:
   Team Coach:                          -select 0 1 2 3 4 5+         
   Team Coach:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
Team Member:                          -select 0 1 2 3 4 5+         
      Chaperone:                          -select 0 1 2 3 4 5+         
      (if required)

Have any of the coaches on this team been to World Finals in the past 5 years (check one)? Yes No

Have any of the team members been to World Finals in the past 5 years (check one)? Yes No
If Yes, explain how many members have been to WF and how many times

Have any teams from this membership been to World Finals in the past 5 years (check one)? Yes No

Have any teams from this School District been to World Finals in the past 5 years (check one)? Yes No

Have any of these coaches or team members been part of a team that received a travel grant
from COU in the past 5 years (check one)? Yes No

Have any teams in this membership received a travel grant from COU in the past 5 years (check one)? Yes No

Are other teams from your School or School District also applying for a COU Travel Grant? Yes No
If Yes to the last question, please provide Membership #/Long Term Problem Name/Division:

WORLD FINALS COST INFORMATION

Number of Odyssey of the Mind World Finals Room/Meal Packages Required - select 0 1 2 3 4 5 6 7 8 9 10
Cost per Odyssey of the Mind World Finals Package (US$) 
Travel Cost per Team Member (US$)     Traveling by: (example: Flying from Orlando to Denver)

Anticipated Total Cost (including only Room/Meal Packages + Travel) for team, coaches, and required chaperones  (US$) 

TEAM FUND-RAISING ACTIVITIES

Describe team fund-raising activities and expected amounts?
Examples: Sponsorships, raffles, dances, direct solicitation, family contributions, school PTA/PTO, etc.
Do NOT include this COU grant application.

Activity Expected Amount Raised (US$):
Activity Expected Amount Raised (US$):
Activity Expected Amount Raised (US$):
Activity Expected Amount Raised (US$):
Activity Expected Amount Raised (US$):
Activity Expected Amount Raised (US$):

Anticipated Total Amount Raised by Team (US$):

COU FUND REQUEST

What is the total amount this team is requesting from COU (US$) :

Please add any additional supporting information you feel is necessary to your application:

PLEASE CLICK ON THE "Submit Form" BUTTON BELOW WHEN YOUR APPLICATION IS COMPLETE. RECEIPT OF APPLICATIONS WILL BE ACKNOWLEDGED BY EMAIL.  IF YOU DO NOT RECEIVE AN EMAIL WITHIN THREE (3) DAYS OF APPLYING, SEND EMAIL TO ron@delcaps.org

THANK YOU.  WE HOPE YOU HAVE A GREAT EXPERIENCE AT THE ODYSSEY OF THE MIND WORLD FINALS.