<p> Individual Junior Tournament</p><p>Reimbursement Form (12/08) Eastern MA Individual Junior Tournament Reimbursements are designed to encourage juniors from Barnstable, Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, and Suffolk counties to participate in competitive tennis events. IJT reimbursements are for full registration fees, and partial travel and lodging costs directly incurred by the participating junior.* Reimbursements are based upon financial need. Today’s Date:______</p><p>Name of Player: ______Age: _____ Sex: Male___ Female___</p><p>Ethnic/Racial Background (optional) Asian/Pacific Rim __ Hispanic/Latino __ Biracial___ </p><p>White/Caucasian __ Black/African American___ Other: (please specify)______</p><p>Name of Parent/Guardian:______(Reimbursement checks will be made payable to this person and sent to the below listed address)</p><p>Address: ______street apt </p><p>______city county zip code</p><p>Telephone Number:______Email:______</p><p>Family Income: Below $25,000___ $25,000-$40,000___ $40,000-$60,000___ Above $60,000____ (documentation required) </p><p>Name of Tournament Dates Played Registration Fee Paid 1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>Type of Player Expense and Total Amounts (actual receipts required)</p><p>Hotel______Transportation (car rental, airfare, bus, train) ______*Reimbursements are partial, usually one-half (½) direct costs to junior. No more than $1,000 will be awarded per player within a fiscal year. Requests must be received postmarked within 45 days of end of tournament.</p><p>Please submit completed form with receipts to: Mr. Damon Accardi, President, USTA E.MA 275 Forest Ridge Rd Concord, MA 01742</p>