Outreach Support

Outreach Club Tuition Support
Contact Information

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

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

First NameLast Name
Club Fee Reimbursement
Reimbursement Option

Option 1 - Up to $200 in matched reduction for outreach member's club fees. ($400 total reduction = $200 reimbursement from Niagara Swimming)Option 2 - Up to $100 credit towards outreach member's club fees. (Full credit of member's club fees up to $100. Reimbursement may not exceed actual fee.)
Option 1 Reduction
Option 1 - This is the total reduction of the member's fees, Niagara contribution will be 50% of this amount up to $200. If the total reduction is greater than $400, please enter $400.
Option 2 Reduction
Option 2 - This is the amount of the member's fees, up to $100, reduced using Niagara funds.
Niagara LSC Contribution
Option 1 Documentation Upload

Upload documentation listing Outreach Swimmer's name and amount of club fee reduction.
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Option 2 Documentation Upload

Upload documentation showing Outreach Swimmer's name and Niagara Swimming credit.
Cancelof
Further Explanation
Please provide any other details that may be helpful in processing your request or that is requested by the approver.
Remittance

Please provide to whom to remit reimbursement
Make Check Payable to: *
Club Name
Send Check to:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check here if this is an address change.

Yes, this is a new address.
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*

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Name of Signer*

First NameLast Name
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Outreach Club Tuition Support

Contact Information

Club Fee Reimbursement

Remittance