NABPT Scholarship Travel Expense Reimbursement Report

2025 JAN - 2025 DEC CYCLE

APTA Pelvic Health & NABPT Scholarship Travel Expense Reimbursement Report

Please complete the report below and attach all accompanying receipts. Please note that you can get reimbursed UP TO USD $250 as part of your scholarship. If you submit receipts in excess of $250, you will be reimbursed up to the $250 maximum limit. If you submit receipts less than $250, you will only be reimbursed for what you spent. Travel includes flights, ground transportation, mileage (if you are driving), or hotel room.

If you have any questions, please contact our office at hello@aptapelvichealth.org with ATTN: NABPT Scholarship Travel Reimbursement Inquiry in the subject line.

GL Code

For Internal Office purposes only. Please leave blank.

Full Name*

First NameLast Name

Name of Committee*

Includes SIGs, Taskforce, Board, etc. If you are an awardee, please state the name of the award.

Scholarship Quarter*

i.e. 2023 Q3 Scholarship Reicpient

Course Name*

i.e. PH1 Lab, OBF Lab

Course City, State*

i.e. St. Louis, MO

Course Dates*

i.e. January 1-2, 2023

What is your Budget Allotment/Scholarship Details

(e.g. Do you have a general scholarship for registration? Do you have $600 for travel, and $200 for Per Diem?, etc.)

Today's Date/Expense Report Submission Date*

Date

Email Address*

example@example.com

Your Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you are driving to a course, you can get reimbursed for the mileage.

2024 IRS Mileage Reimbursement Rate: 67 cents per mile (Source)
We will do our best to update this expense form to reflect the latest reimbursement rates however, please always refer to the latest mileage rate posted at www.irs.gov as it can change year-round.
All in US currency.

Total Airfare*

If none, enter $0

Total Hotel*

If none, enter $0

Total Taxi/Parking*

If none, enter $0

Total Rental Car*

If none, enter $0

Total Other*

If none, enter $0

TOTAL EXPENSE REPORT*

I certify that all information entered above is valid and true.

Upload Receipts*

Upload a File

(The preference is for PDF versions, however, JPG/PNG versions will be accepted. Full receipts must be visible and legible. Incomplete/blurry/illegible receipts will not be accepted as valid. This form is not complete if your receipts are not submitted. Form submitted without receipts WILL NOT BE PROCESSED)

Comments/Notes: