Centre Global Off-Campus Reimbursement Form
Requested by
*
First Name
Last Name
Email
*
yourname@provider.com
What is your relation to/position with Centre Global programs?
*
Request Submission Date
*
-
Month
-
Day
Year
Date
What is this reimbursement request for?
Meal with students
Activity with students
Student travel
Other
Date of activity (on receipt)
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Month
-
Day
Year
Date
Explain details of the expense (what was it for, location, student names, etc)
*
Business name on receipt
*
What currency is the receipt in?
*
Example: US dollars (USD), New Taiwan Dollars (NTD), EUROS, Japanese Yen, Mexican Pesos, etc.
Additional receipts (if applicable)
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of
Additional receipts (if applicable)
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of
Total amount
*
Upload a clear copy of the receipt (JPEG, PNG, or PDF file)
*
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of
Other details (i.e., if not already on file with Centre College, please provide your bank name, bank address, bank account number, full name on the account, and the SWIFT or IBAN for your bank).
Submit
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