Graduate Reimbursement Request

Graduate Reimbursement Request

Please note that receipts are required in order to complete your request - thank you!
Graduate's name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number
Email address
example@example.com
Pilot Dog's name*
Pilot Dog's weight (pounds)*
Pilot Dog's age (years)*
Expense Details

Please provide the date, the description (veterinary care, dog food, etc.), and the cost of the item/service.

What is eligible for reimbursement:
- Dog food: Maximum of $75 bi-monthly
- Routine (preventive) veterinary care, including:
  - Vaccines
  - Nail trims
  - UTI treatment
  - Ear infections
  - Fecal tests
  - Flea/tick and heartworm preventatives
  - Any other treatments/surgeries on a case-by-case basis
- One-time crate expense
- Dog treats/Nylabones
If you have any questions, please call us at 614.221.6367 and we'll be happy to help!

Expenses list*

	Date (mm/dd/yyyy)	Product/Service Description	Cost
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