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Swim School Partner Submission for Reimbursement

Please fill out all fields and upload documents for reimbursement.

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Today's Date

Company Info

Business Name

Contact Name

First

Last

Phone Number

Funding Payable to (Name on Check)

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Scholarship Info

*ALL sections must be filled out in order to advance to the next section or be able to submit the form

FEI Number

Number of Children Served for this Submission Only

Lessons

Date Lesson Started

Date Lesson Completed

1. Spreadsheet

Spreadsheet Upload

*MUST INCLUDE THE FOLLOWING INFO:

• Child/Children’s Name
• Age
• Zip Code
• Financial Qualifying Information
• Skill Level at the Start of Lesson
• Skill Level at the Completion of the Lesson
• Ratio of the Lessons
• Number of Lessons Obtained
• Cost per Child/per Lesson

Please visit this link to download our preferred template: Download Sample Template