OLYMPIC SCHOLARSHIPS FOR ATHLETES “RIO 2016”
QUALIFICATION TRAVEL SUBSIDY FORM
National Olympic Committee
Athlete’s
given name(s)
Athlete’s
family name
Sport
Discipline
 The Qualification Travel Subsidy is to cover the athlete’s transport costs (including
transport of equipment) to participate in Olympic qualification competitions.
 All other costs (entry fee, board and lodging, coach’s travel, etc.) relating to participation in
the competition must be covered by the monthly scholarship.
 For air tickets, only the price of return tickets in economy class for the most direct route
will be reimbursed.
 Each transport ticket must be numbered in the top right hand corner and presented as an
annex to this form.
 Please list the currency used, the amount of the specific expenditure as well as the
amount of the specific expenditure in USD & the exchange rate in the relevant space
provided.
Please note that just one reimbursement per athlete will be made upon receipt of this
completed form with the accompanying proof of purchase. It is therefore requested to wait
until your athlete uses the full budget, as written in the scholarship allocation letter, or that
he/she is qualified or that there are no more qualification opportunities left, before submitting
a request for reimbursement.
N°
Dates
(dd/mm/yyyy)
Qualification
obtained
Competition name and location
Ticket cost
Ticket cost
(Local currency)
(USD)
Yes / No
1.
2.
3.
4.
5.
Total
Athlete’s signature:
Approved by NF:
Approved by NOC:
NOC
Stamp
This form is also available on NOCnet http://extranet.olympic.org/nocnet
Olympic Solidarity – 2013–2016 World Programmes
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