DFPA Reimbursement Form

If you are a member of the Department of Fine and Performing Arts and you have been approved for using departmental funds for expenses supporting professional development, academic or public programming and need to be reimbursed, please submit this form.

For employees, reimbursements will be directly deposited into the bank account that your checks are deposited, for non-employees the process could take longer.

Please note that any reimbursements must be in accordance with university travel and business expense policies, listed here: https://www.luc.edu/finance/expensepolicy.shtml

Some special considerations:

As a tax exempt 501-3c organization, the Loyola does not reimburse sales tax. Any tax on reciepts will not be reimbursed.
Meal and Logdging reimbursements may not exceed reimbursement standards as outlined in the US General Services Administration and by the university. See tables here.
If you use a personal vehicle for travel, the current mileage reimbursement is here. Please note that you will need to provide a google map with the orgin and destination addresses, with total trip mileage noted as part of your documentation.
For Airfare, when compiling documentation, the confirmation receipt with ticket number must be provided.
For International Travel, any expenses incurred in a foriegn currency must be converted to U.S. dollars for reimbursement. It is the responsibility of the requestor to provide documenation supporting the conversion rates and dates used for the calculation of the requested reimbursement. You can use this currency convertor https://www.xe.com/currencyconverter/

If you have any questions or concerns regarding your reimbursement request, please reach out to Patricia Moore @ pmoore2@luc.edu. Processing time is roughly 3-4 weeks.

Finally the LUC Finance office must recieve reimbursment requests withint 90 days of travel or submissions will be charged tax on awards.

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employee Status*

FacultyStaffStudent Worker

Email*

example@example.com

Phone Number*

Area CodePhone Number

Expense Category

Professional Development (includes travel, conferences, etc)Course Related Expense (software, equipment, supplies, etc)Programming Related ExpenseOther

If associated with a Faculty Development Award, please provide the Conference Name or Submission Title

Please describe a brief detail of the expense to be reimbursed.

Month requesting reimbursement*

Use of a Personal Vehicle is part of this reimbursement Request

YesNo

Attach Google Maps for all legs of journey traveled with personal vehicle

Browse Files

For all mileage being reimbursed a print out of the google map showing the origin and destination with miles included is required for back-up documentation.

Total Miles Travelled

If using a personal vehicle, enter the total mileage to be reimbursed.

Total mileage expense

This total is automatically calculated from the mileage total above based on current (2021) rates of reimbursement of .56 a mile.

Total Number of Receipts Submitting

We want to make sure we have all of the documents you are submitting, please include a count of the receipts associated with this reimbursement.

Total Reimbursement Requested

Please include the total dollars you are requesting to be reimbursed (without mileage).

Total Reimbursement with mileage

This field is automatically calculated if you have mileage.

Please upload any receipts or backup documentation*

Browse Files

PDF is the best format. If you have multiple receipts, it is also helpful if you upload a tracking document (excel, word - that outlines the expenses). Receipts that are not legible will need to be resubmitted and will delay the processing of your request. The DFPA scanner in the main office can make PDFs from your receipts. Reminder, sales tax cannot be reimbursed.

Signature