YES/FLEX Host Family Incidentals Allowance Reimbursement Request Form

YES/FLEX Host Family Incidentals Allowance Reimbursement Request Form

YES/FLEX Host Family Reimbursement Request Form

Host parents must submit their expenses and receipts to AFS-USA in order to be reimbursed; the allowance is not paid out in advance to host families. Students are NOT allowed to submit for reimbursement of these funds.
Host Family Name*

First NameLast Name
Host Family E-mail*
Your E-mail Address
Student's Program*

YESFLEX
Student's Country*
Student's Name*

First NameLast Name
Address (for the reimbursement check to be sent to)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What type of reimbursement request are you making today?*

Host Family IncidentalsImmunization/Glasses/Sport Physicals

Host Family Incidentals Allowance Details
Examples of allowable expenses for host family incidentals are:
- Activity/school participation fees
- Gym or school sports uniforms/equipment
- School event fees
- School supplies
- Weather specific clothing/shoes
- Yearbooks
- Required school-administered field trip fees (1 day in length)
Examples of expenses that are not allowable are:
- Mobile phones or laptops
- Clothing that is not weather specific
- Jewelry
- Gifts for student’s family members
- Student meals
- Vacation related expenses
- Electronics
- Luggage Fees (students will receive a stipend for end of stay luggage fees)
- School-administered trip fees (more than 1 day in length)

Host Family Incidental Reimbursement Request

Rows	Purchase Date	Description of the item	Cost
1
2
3
4
5
6
7
8
9
10

Host Family Incidental Reimbursement Request Total*
Please upload your receipts. The receipts must follow these requirements:
- Clear, not blurry images
- The image must include the date and the business name
- All information must match with the information above
- If the receipt has multiple items, please highlight the items you want to get reimbursed (separate from personal purchases)
- If you are requesting reimbursement for school expense and you did not receive the receipt, please ask the school for an invoice.
Upload Receipts*

Cancelof
Please leave any additional comments here:

Immunizations, Glasses, and Sports Physicals Details
There are Sponsored Programs funds available for host families to cover these expenses:
- Immunizations
  - Reimbursable if required by the school for continued school enrollment. Documentation from the school is required.
  - 2nd and 3rd dose boosters, COVID and Flu Shots are NOT Reimbursable by insurance or grant. If the school provides documentation indicating the lack of a booster, COVID or Flu shot would jeopardize continued enrollment, the costs will be reimbursed.
  - If host families prefer that their student have the COVID and/or Flu vaccine, and this vaccine is not required by the school, they may submit this expense to be covered by the allotted $300 Host Family Incidental Allowance.
- Glasses
  - Covered only if student's previous glasses are lost or damaged. Frames/lenses covered up to $100 and eye exam (if student does not already have a prescription) covered up to $100.
- Sports Physicals
If you have any medical expenses that are not the above, please contact your Support and Learning Department Specialists to see if they are covered by the insurance.

Note: If you submitted for the host family incidentals earlier in this form, you do not need to reenter them here.

Immunizations, Glasses, and Sports Physicals Details

Rows	Purchase Date	Description of Item	Cost
1
2
3
4
5
6
7
8
9
10

Total Amount from this section*
Please upload your receipts. The receipts must follow these requirements:
- Clear, not blurry images
- The image must include the date and the business name
- All information must match with the information above
- If the receipt has multiple items, please highlight the items you want to get reimbursed (separate from personal purchases)
- If you are requesting reimbursement for school expense and you did not receive the receipt, please ask the school for an invoice.
Upload Receipts Here*

Cancelof
Please leave any additional comments here:

Total from Host Family Incidentals *
Total Amount from Immunizations, Glasses, or Sports Physicals*
Total Amount of Reimbursement*
I certify*

I certify that all information entered is valid and true.
Date of Signature*

MonthDayYear
Date
Please Type Your Signature (Host Parent)

First NameLast Name
Should be Empty: