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
Bethesda, MD
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
Monterrey, Nuevo Leon-Mexico
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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Submit
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