School:____________________
|
BASEBALL | FIELD HOCKEY | SOCCER | VOLLEYBALL |
BASKETBALL (See 4. below) | GOLF (Team) | SOFTBALL | WATER POLO |
CROSS COUNTRY (Team) | GYMNASTICS (Team) | TENNIS (Team) | (please circle one) |
SCHOOL:__________________________________ | SPORT:________________ Boys____ Girls____ | ||||
1. DATE OF CONTEST: _______________ |
SITE:_________________________________ | ||||
Auto Round Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
2. DATE OF CONTEST: _______________ |
SITE:_________________________________ | ||||
Auto Round Trip Mileage___________ | $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
3. DATE OF CONTEST: _______________ |
SITE:_________________________________ | ||||
Auto Round Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
4. DATE OF CONTEST: _______________ |
SITE:_________________________________ | ||||
Auto Round Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
TOTAL DUE |
$__________________ |
The above information is accurate and travel subsidy is hereby requested on behalf of my school.
______________________________
__________________
Athletic Director's Signature
Date
Please return to CCS within 10 DAYS OF THE SCHOOL'S LAST PLAY-OFF CONTEST. |
CCS, 1691 Old Bayshore Highway, Suite
200, San Jose, CA 95112 |
LATE SUBMISSIONS WILL NOT BE HONORED. |
Phone: 408-441-9505 Fax: 408-441-9509 |