AMS Disbursement Request
A. PERSONAL INFORMATION
Name
*
Email
*
Phone
*
Format: 000-000-0000.
Address
*
City
*
State
*
Zip
*
I am completing this form for:
Please Select
Athlete Funding
Coach Funding
Officials Funding (Officials must have provided notice to the Officials Chair prior to officiating the meet in which seeking remibursement.
B. EXPENSES
Rows
Date
Items
Purpose
Amount
1.
2.
3.
4.
5.
6
7
Expense Total
Proof of Participation
Browse Files
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Choose a file
You must provide receipts for all expenses listed above
Cancel
of
Receipts:
Browse Files
Drag and drop files here
Choose a file
You must provide receipts for all expenses listed above
Cancel
of
C. MILEAGE
Rows
Date
From/To
Purpose
Miles
1
2
3
4
5
6
7
Total Miles
GSA Rate*
Mileage Total
*
Click Here for current GSA Mileage Rate
D. CASH ADVANCE
Rows
Date Required
Date of Event
Purpose
Amount
1
2
3
For Cash Advances, you must submit an Expense Tracking Form to the AMS Office within 10 days after the event/purpose. Receipts for all expenditures must accomany the form. Any unused funds must be returned to AMS.
E. MAILING INSTRUCTIONS
Total Reimbursement
Total Advance
Payable To:
*
Mail Check To
*
Address listed in Part A above
A Different Address
Alternate Mailing Address
Please sign in the space below
Submit
Should be Empty: