Expense Reimbursement Request Form
This form is to submit a request for reimbursement. This means that pre-approval of reimbursement by the Executive Director is recommended to expedite dispersal of funds.
Name
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First Name
Last Name
Email
*
example@example.com
Indicate if you are an employee or a volunteer.
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Employee
Volunteer
What is the date(s) that the expenses occurred?
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Enter start and end date if the report spans multiple days.
Describe the reason for the expense(s) and the associated Program or Committee, if applicable.
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What is the total amount of your reimbursement request?
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Please make expenses in USD $XZ.CC format
Enter the details of your request; date, amount, purpose, if different from above, and expense category, if known.
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Detailed responses are less likely to have follow up questions before being approved/processed
Major Expense Categories
7500 - Professional Fees: e.g., artist fees, travel, housing, etc. 7600 - Marketing Expenses: e.g., professional fees, printing 8000 - Occupancy Expenses: e.g., telephone, utilities, etc. 8500 - Other Expenses: e.g., venue, supplies, hospitality, video production, etc. 8600 - Production Expenses: e.g. lodging, staff travel, equipment rental, etc.
These are major expense categories. Specific sub-categories will be determined by the approver or accountant.
Was this expense approved by your Committee Chair or Executive Director in advance (prior to purchasing)?
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Executive Director
Committee Chair
No, it did not have advanced approval
Board of Directors (for Executive Director)
File Upload - please upload clear images of receipts here
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Acknowledgment
Thank you for submitting an expense reimbursement request. Approval of the request will be sent from our Executive Director with instructions on the delivery of funds. Expenses are typically paid via paper check, but direct deposit may also be available depending on the nature of the expense. For questions, please contact kristina@taikocommunityalliance.org
By electronically signing below, you attest that these funds are accurate, true, and are for TCA purposes. You also acknowledge that reimbursement of these expenses will not result in a conflict of interest for either you or TCA. If these expenses have been falsified, falsely reported, or found to generate a conflict of interest, TCA reserves the right to refuse reimbursement and/or request repayment of these funds.
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