Student Reimbursement Request

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

NUID*

Class/Program: What class, club or program was the purchase made for? *

Faculty Advisor Approval Required

This request will be routed to your faculty advisor for approval. Please enter their full name and correct email address below.

⚠️ Double-check the email carefully: Faculty email addresses end in .unl.edu, not .huskers.unl.edu.⚠️

Incorrect email addresses may prevent delivery and could result in your request being denied.

Faculty Advisor Name: *

First NameLast Name

Faculty Advisor Email: *

example@example.com

What are you requesting reimbursement for?

Goods/ServicesMileage

Date purchase was made? *

MonthDayYear

Total amount of goods/services? *

What city and state was the purchase made in? *

Street Address

Street Address Line 2

CityState / Province

Business Purpose: Please provide a detailed explanation of why you purchased these items?*

You must upload detailed, itemized receipts for each purchase. You may upload one or more receipts using the button below. All receipts must be in English.

Receipts*

Complete the itinerary below for all the mileage you are requesting. For example:

Date	Departed From	Arrived At	Total Miles
12/31/2024	Lincoln	Des Moines	189
12/31/2024	Des Moines	Omaha	134
1/1/2024	Omaha	Lincoln	59

Please note, we do not pay mileage within the city of Lincoln.

Itinerary

	Date	Departed From	Arrived At	Total miles
Trip 1
Trip 2
Trip 3
Trip 4
Trip 5
Trip 6
Trip 7
Trip 8
Trip 9
Trip 10

Total Mileage Reimbursement