Coach Stipend Request

Coach Stipend Request
Requester Information

Please provide contact information for the person making the request.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Payee

Please provide the contact information for the coach receiving the stipend. They may be required to fill out additional paperwork prior to final payment.
Name

First NameLast Name
Title
Provide the position for which they are being paid.
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Description of Work Provided
Please provide title, function, and date(s).
Stipend Amount
Budget Line
By signing below, you attest that all information provided in your request is true and accurate. In addition, your request is in accordance with the Bylaws and Policies and Procedures of Niagara Swimming, Inc.
Signature

Clear
Name of Signer

First NameLast Name
Should be Empty:

Requester Information