RIG Expense Proposal Form
Please complete this form to propose an expense for approval. Be as detailed as possible to ensure timely review and processing.
RIG Name
*
Please Select
Albany, NY
Birmingham, AL
Burlington, VT
Central Virginia-Charlottesville/Richmond
Chicago, IL
Cleveland, OH
Cleveland Clinic, OH
Columbus, OH
Dallas, TX
Detroit, MI
Gainesville, FL
Houston, TX
Indiana
Irvine, CA
Los Angeles, CA
Montreal, QC
Nashville, TN
New England
New Haven, CT
New York, NY
Newark, NJ
Northern California
Philadelphia, PA
Phoenix, AZ
Portland, OR
Rochester, MN
Winnipeg, MB
Requester Information
Name
*
First Name
Last Name
Credentials
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Expense Details
Expense Title
*
Detailed Description
*
Expected Benefit/Outcome
*
Estimated Total Cost
*
Itemized Breakdown
Item
Description
Quantity
Unit Price
Total
1
2
3
4
Date Expense Will Occur
*
-
Month
-
Day
Year
Date
Deadline for Approval
-
Month
-
Day
Year
Date
Submitter signature
*
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