FCLIR General Expense Reimbursement

FCLIR General Expense Reimbursement
If you are requesting reimbursement for the use of your Zoom account for FCLIR-related work (hosting a seminar, hosting committee meetings, etc.) please use THIS FORM.
Today's date

MonthDayYear
Date
Your name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Expense Date

MonthDayYear
Date
Expense for

Other
Expense category(can be multiple items)
Expense Total:
Expense Description:
Upload your expense receipt

receipt required for all expense reimbursement requests
Cancelof
Note:
Include what committee or FCLIR officer authorised this expense, if not stated above
Reimbursement checks will be mailed from Five Colleges, Inc., and may take up to 2 weeks to be issued.
Should be Empty: