5CLIR Zoom Expense Reimbursement

5CLIR Zoom Expense Reimbursement

2020-2021 REQUEST FORM
Today's date *

Month Day Year
Date
Your name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number

Area Code Phone Number
Zoom use schedule *

Fall semester, 4 months Spring semester, 4 months Monthly meeting, 10 months
Zoom use category *

Seminar host ($60 for 4 mos per semester) Program host ($60/ 10 mos of calendar year) 5CLIR Council host ($150 for 10 mos of calendar year) 5CLIR Committee host ($150 for 10 mos of calendar year)
Upload your expense receipt

Browse Files
receipt required for all expense reimbursement requests Cancel of
Note:
Reimbursement checks will be mailed from Five Colleges, Inc., and may take up to 2 weeks to be issued.
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