1/19/2020 Center of Excellence Annual Report

Application/Annual
Report
Please complete the report below and upload any
supporting documentation

Contact Information
* Club/Team Name

USA Cycling Club ID

* Primary Club Contact

First Name Last Name

* Primary Club Contact Email

* Mailing Address

Street Address

Address Line 2

City State / Province / Region

Postal / Zip Code United States

Primary Club Contact Phone

Secondary Club Contact (if applicable)

First Name Last Name

Secondary Club Contact Email

Secondary Club Contact Phone

Board Chair

First Name Last Name

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Board Chair Email

Club Website or Landing Page
https://

Goals
Mission Statement

Briefly summarize your 2020 COE club/team goals

USA Cycling Licensed Riders

How many USA Cycling licensed junior and U23
riders attached to your team in 2019?

How many athletes graduated to collegiate

programs in 2019?

List program graduates and their collegiate team

USA Cycling Coaches

How many USA Cycling Coaches
does your program have?

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Please list all names, license numbers and level of

current COE USAC licensed Coaches

USA Cycling Events

How many USA Cycling sanctioned events were
operated by your COE club team in 2019? This may
include clinics, training races or other competitive
events

Please list all event names, dates and USA Cycling

permit numbers

Results
How many top-5 results did your team have at any
USA Cycling National Championship event in 2019?

How many top-10 results did your team have at

any USA Cycling National Championship event in
2019?

Please list 2019 USA Cycling National

Championship results by your junior and U-23
riders from any discipline

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How many USA Cycling National Development

Program Team qualifiers did your team have in
2019?

List USA Cycling 2019-2020 National Development

Program Team qualifiers in any discipline

How many world team qualifiers did your team

have in 2019?

List world team qualifiers and subsequent results

in any discipline

Supporting Documentation
Please upload your organization's last IRS 990

Please upload your USA Cycling Club Roster

Please upload your 2020 Schedule

Please upload your completed IRS w-9

Please upload your grant request along with

specific information on how the grant will be used

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Please upload your 2020 jersey image

Submit

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