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CONNECTICUT SWIMMING |
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| Application for an Educational Grant |
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| Name |
Club |
| Address |
| Home Telephone |
Office Telephone |
| Email |
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| Position |
Length of Employment |
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| Please list all activities and events in which you participated during the period September 1,
2005 -
August 31, 2006 (please refer Coaches Educational Incentive Program description for
eligible activities/events): |
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| Date: |
Location: |
Activity/Event: |
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| Coach's Signature |
Date |
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| Complete and forward this form no later than
September 15,
2006
to: |
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Connecticut Swimming |
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27 Cortland Lane |
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Glastonbury,
CT 06033-3305 |
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860-657-1167 (fax)
office@ctswim.org |