Payment Request Form
For Reimbursements, Invoices, and Payments
Your name
*
First Name
Last Name
Email address (If you are an NJLA member, please use the address you use to log into njla.org.)
*
example@example.com
Is this payment request for any of the following
Scholarship
Mini-grant
NJLA Group yearly allowance (see njla.org/funding-for-sections-and-committees for more info)
Other
Which scholarship were you awarded?
*
Equity
Course
Karma
What is your student ID number?
*
What semester is this for?
*
What is the name of your NJLA Group?
*
What is the purpose for which payment is being sought?
*
Amount
*
Is there a deadline for this payment?
-
Month
-
Day
Year
Date
Make check payable to:
Name
*
Address
*
Phone Number
Upload invoice or receipt
*
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