SNS National Evaluator Reimbursement Program
Thank you for helping SNS Officials. Please fill out completely for reimbursement.
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 #
*
Reimbursement Request
Name and Date of Meet:
Meet Ref Name and Contact:
*
AIRFARE, RENTAL CAR or Uber / Lyft fees during meet, 50% of ACCOMMODATIONS. Host team pays 50% of Accommodations. (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) (effective 6/1/2025)
*
Travel Type
Date
Billed Amount
1
Air
Hotel
2
Air
Hotel
3
Air
Hotel
4
Air
Hotel
5
Air
Hotel
6
Air
Hotel
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. SNS prefers to make payments through Zelle. Zelle payments will be made as applications are approved. Checks will be mailed out within 1 week after submission.
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
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