FCLIR General Expense Reimbursement

5CLIR Expense Reimbursement
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*

Area CodePhone Number
Expense Date*

MonthDayYear
Date
Expense for*

Administrative/ OfficeCouncil / Exec CommCurriculum (incl Preview)Seminar (Moderator)Membership/OutreachOngoing (Recurring) ProgramOne-time Event or ProgramGreat DecisionsTechnology (not incl Zoom)
Expense category(can be multiple items)*

Copying & printingPostageTravel & parkingEvent tickets/reservationsAdmission fees/ donationsFood & beverage (non-alcoholic)Beverage (alcoholic)SuppliesMinor EquipmentSpeaker fee/ HonorariumPetty CashOther/not listed (describe below)
Expense Total:*
Expense Description:
Upload your expense receipt

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

5CLIR Expense Reimbursement