Campus Life Expense Form

Reimbursement
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Direct Deposit Form*

Campus Life Program expenses are typically reimbursed by Direct deposit, please upload your Direct deposit or Void Cheque form here.
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File Upload*

Label each receipt as follows: Your Name, Receipt 1 (Karina Stellato, Receipt 1) *Please make sure your receipt number corresponds with the information in the chart below*
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What budget line should your purchases come from?*

Program Supplies [5404]Programming [5114]Post Cards [5406]Promotional Items/Prizes [5502]Mentorship Training [5111]SMCheese [5114]
If you selected multiple budget lines in the previous question, please, explain which purchases fall under the indicated budget lines.
Eg. You are submitting multiple receipts for purchasing food for the commuter lounge AND decorations for the commuter lounge. State: Food (Loblaws) = 5114; Decorations (Dollarama) = 5404
Please provide the total amount to be reimbursed from the above receipts*

Honourarium
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SIN Number*
In order to write cheque, your SIN number is required.
Date of Birth*

MonthDayYear
Date
Direct Deposit Form*

Campus Life Program expenses are typically reimbursed by Direct deposit, please upload your Direct deposit or Void Cheque form here.
Cancelof

Statement of Understanding

Please read and agree to the statement of understanding below in order to complete your request.
1. I, your full name* understand that completion of this form is the first step to being reimbursed for expenses accrued for Campus Life events. Reimbursement is subject to review by Campus Life staff. Please allow at least 3 weeks for reimbursement from the time of submission.
Should be Empty:

	Receipt Date (e.g. 2023-05-01)	Vendor Name (e.g. Tim Hortons)	Receipt Total - Including Tax (e.g. 23.23)	Receipt Tax (e.g. 2.07)	Purpose/Event (e.g. Commuter Orientation Gift card for Karina Stellato)	Portfolio (e.g. Mentorship)
Receipt 1
Receipt 2
Receipt 3
Receipt 4
Receipt 5
Receipt 6
Receipt 7
Receipt 8
Receipt 9
Receipt 10

Reimbursement