2025 SCEMA Reimbursement Request Form

Reimbursement Request Form

Thank you for all your hard work in support of the 2025 Academy!
Faculty Member Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number

Round-trip economy air or train fare plus taxes/feesMileage for round-trip travel by personal vehicleCar rental for travel to MemphisRideshare / Taxi expenses while in MemphisHotel / Lodging

Please enter total requested reimbursement amount for air/train fare:
Please upload your receipt(s) for air/train fare:

Browse Files

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Please enter total requested reimbursement amount for mileage by personal vehicle:
Please upload a map / itinerary for mileage by personal vehicle:

Browse Files

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Please enter total requested reimbursement amount for car rental:
Please upload your receipt(s) for car rental:

Browse Files

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Please enter total requested reimbursement amount for rideshare / taxi expenses:
Please upload your receipt(s) for rideshare / taxi expenses:

Browse Files

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Please enter total requested reimbursement amount for hotel / lodging:
Please upload your receipt(s) for hotel / lodging:

Browse Files

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Honorarium Information

If your reimbursement is payable to your employer or another entity, please enter your personal information below for processing of your Academy honorarium.
My Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload your completed W9 form.

Upload Files

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Click "Submit Form" Below
Thank you for submitting the SCEMA Reimbursement Request form.

We will review the request and contact you if additional information is needed. Payments will be processed as soon as possible, but likely no later than July 25, 2025. If you have questions or concerns, please contact Mark Weston, Staff Attorney / Operations Lead at The Works, Inc. (mark@theworkscdc.org)

- SCEMA
Should be Empty:

Reimbursement Request Form