Guaranteed Ride Home Reimbursement

Guaranteed Ride Home Reimbursement

The Guaranteed Ride Home program will remind you to update your account information each calendar year. The program provides two free rides per calendar year to those who regularly carpool, vanpool, ride the bus or bike to work. Please view the full program rules and restrictions and register for the program before submitting your reimbursement.

In order to qualify for reimbursement, you must be confirmed as a registered participant of the WAY TO GO program at least three days before the trip date. The GRH program has the right to request additional documentation or information, if needed. If the program administrator determines the use of GRH was invalid, no reimbursement will be issued. Reimbursement requests (including receipt) must be submitted within ten (10) days of the GRH trip date. After your receipt is submitted, you will receive your reimbursement check within 30 days.

Please note: Reimbursements may include the cost of a tip if you choose to tip your driver. Tips greater than 20% will not be reimbursed. If you choose to tip greater than 20%, you will be responsible for the difference. Please note your tip amount in the additional details section of the form.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

How did you get to work on the date of your Guaranteed Ride Home?*

How did you get home?

TaxiTransportation company (i.e., Uber, Lyft)

Date of your ride home

Date

Time of your ride home

Hour Minutes

AM/PM Option

Starting/pick-up address*

Destination/drop-off address*

Reason for ride

You or an immediate family member suffered an illness, injury, or severe crisisYour carpool or vanpool vehicle broke downYour carpool or vanpool driver had to leave early or stay lateYou had to respond to an emergency at your residenceYour commute bicycle broke down on way to/from workYou were asked by supervisor to work unscheduled overtime (supervisor confirmation required)Other (Please detail in “provide additional details” section)

Reimbursement request cost

In US dollars.

Please provide any additional details about your trip that might be pertinent to the GRH program staff.

Where would you like your reimbursement check sent?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please include a copy of your ride receipt. The receipt must include information such as date, time, origin, destination, service provider and cost. Reimbursement requests (including receipt) must be submitted within 10 days of GRH trip date.

Ride Receipt

By submitting this form, you certify that all the information stated above is true. The GRH program has the right to request additional documentation or information, if needed. If the program administrator determines the use of GRH was invalid, no reimbursement will be issued. You are eligible to take a trip three days after registration.

Please verify that you are human*

Work or School Information