Name of athlete: _______________________

Date of Birth: _____________________

USSA #  ______________________________

FIS # ____________________________

FIS Points

DH: _______

SL: _______

GS: _______

SG: _______

USSA Points

DH: _______

SL: _______

GS: _______

SG: _______

Club/Program:  ________________________

Indicate Event/Race Series Applying for: ___________________________________________________
(Example – Topolino Shootout, WR FIS Elite)

Are there parts of the event series athlete is already qualified for? If yes, please list:

Comments as to why this athlete should be entered on Development Quota:

Comments regarding this athlete’s career and potential, including recent best results:

Comments regarding this athlete’s failure to qualify according to procedures in place:

Nominated by: ______________________

Affiliation: _________________________

Phone: ____________________________

E-mail : ____________________________