LPA Reimbursement Request
Requests for reimbursement are reviewed every Sunday morning. Receipt(s) must be included either as an uploaded photo or an uploaded file. Checks will be made out to the name under "Submitted by" on the form.
Submitted by
*
First Name
Last Name
E-mail
*
Date
*
/
Month
/
Day
Year
Date
Associated Event/Program
*
Expense Description
*
Amount
*
Please enter a number without a dollar sign.
Take a Photo of Your Receipt (Usually for a Smartphone)
OR
Upload a File with Your Receipt (Usually for a PC)
Upload a File
Cancel
of
Address (to mail check to)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: