Expense Form
USAPrides Scholarship Reimbursement or Expenditure Request Form
Name
*
First Name
Last Name
Pronouns
Business Name, if required
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Documentation of Expense
Expenditure Type
*
Scholarship/Grant
Conference Expense
Operating Expense
Other Expense
Total Payment Amount
*
Contract, Invoice, or Receipts of Expenses to Reimburse such as Travel and Lodging for Scholarship/Grant
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Payment Process
Payment Type
*
Zelle
Paper Check
Venmo
Paypal
Other, by agreement
Online Payment Link, if needed
IRS W-9, if Expense or Scholarship/ Grant is over $600
Browse Files
Drag and drop files here
Choose a file
Go to the IRS website for the form: https://www.irs.gov/pub/irs-pdf/fw9.pdf
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Submit
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