Officials Travel Reimbursement Program
Name
*
First Name
Last Name
Suffix
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Your E-mail Address
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
USA Swimming #
*
Eligibility
Date you became a certified Official?
Sessions worked in the last swimming year (Sept 1 - Aug 31):
Active on the SNS BOD?
Please Select
Yes
No
If yes, what capacity?
Reimbursement Request
Tier Requested:
*
Tier 1: Sectionals / Futures or Zone Meet $200
Tier 2: Pro Series Meet $400
Tier 3: National / JNAT Meet / World Aquatics $600
Olympic Trials $1500
Name and Date of Meet:
Acknowledgements:
*
I CONFIRM THAT I HAVE NOT PREVIOUSLY REQUESTED FUNDING FOR THIS TIER FOR THE SAME SWIMMING YEAR.
I CONFIRM THAT I AM NOT RECEIVING FUNDING FROM ANOTHER SOURCE FOR THESE EXPENSES.
I CONFIRM THAT I HAVE OR WILL BE WORKING A MINIMUMOF 80% OF THE SESSIONS AT THIS MEET.
(Please include documentation of Sessions served with scan/copy of Deck Pass reflecting the Sessions served or signature of Meet Referee of that meet vouching for your sessions served)
*
Browse Files
Accepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif (no .HEICs)
Cancel
of
Meet Ref Name and Contact:
*
AIRFARE, CAR RENTAL, ACCOMMODATIONS UP TO THE AMOUNT ALLOTTED (Receipts/Invoices should reflect the name of the Official submitting the Reimbursement Request; for cases where costs are shared, documentation from Credit Card, Payment Method, etc also need to be included)
*
Rows
Travel Type
Date
Billed Amount
1
Air
Accommodations
Ground
2
Air
Accommodations
Ground
3
Air
Accommodations
Ground
4
Air
Accommodations
Ground
5
Air
Accommodations
Ground
6
Air
Accommodations
Ground
Upload receipt for item 1
*
Upload a File
file types allowed: pdf, doc, docx, xls, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif (no .heic)
Cancel
of
Upload of receipt for item 2
Upload a File
Cancel
of
Upload of receipt for item 3
Upload a File
Cancel
of
Upload of receipt for item 4
Upload a File
Cancel
of
Upload of receipt for item 5
Upload a File
Cancel
of
Upload of receipt for item 6
Upload a File
Cancel
of
Total Reimbursement Request
*
e.g. 198.47 (no dollar sign). Amount can not exceed Tier Total
Payment Instructions
SNS prefers to make payments through Zelle
Payment Requested as:
*
Zelle
Check (to mailing address above)
For Zelle, phone number on account:
For Zelle, email on account:
Any other notes regarding this submission?:
e.g. shared room, circumstances at meet
I confirm all information contained in this form is valid and true.
This checkmark implies a signature
Submit Form
2026 Updated Form
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