REQUEST FOR
POTOMAC VALLEY SWIMMING TRAVEL ASSISTANCE
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Seniors Juniors Special
Spring Summer (circle appropriate)
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Use a separate form for each meet/special event
QUALIFIED:
I attest that the following athlete(s) have met all established PVS Travel Assistance eligibility requirements , including the prescribed meet participation requirements, and have participated in an individual event in the meet indicated above. I have also attached a meet participation certification form for each athlete listed:
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APPEALS:
Although the athlete(s) listed below did not meet the established PVS Travel Assistance eligibility requirements for the meet indicated above, I believe that the circumstances detailed below justify an exception (use additional sheet(s) as necessary).
| NAME: | USS/PVS REGISTRATION #: | EVENT(S) SWUM AT MEET:
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| Head Coach's Name | Head Coach's Signature | Date
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See instructions, procedures, and policy
Issued: 06/96