Receipt of Prize Money/Reimbursement Form

Student-Athlete Name:*

Student-Athlete Email Address*

Student-Athlete Sport:*

Name of competition/event:*

Date(s) of Event:*

Location of Event:*

Information about Organization providing prize money/reimbursement:

Name of Organization providing prize money/reimbursement:*

Amount of prize money received/reimbursement to be received:*

Is this organization a sponsor of the event?*

Amount of transportation costs:*

Please attach receipts for transportation costs:

Max. file size: 2 MB.

Amount of lodging costs:*

Please attach receipts for lodging costs:

Max. file size: 2 MB.

Amount of meal costs:*

Please attach receipts for meal costs:

Max. file size: 2 MB.

Amount of other costs:*

Description of other costs:*

Please attach all receipts for other costs:*

Max. file size: 2 MB.

Total Costs/Expenses*