Bursary Reimbursement Request Form

Bursary Reimbursement Request Form
This form facilitates the payment of out of pocket travel expenses incurred while attending the 2025 Equally Well Conference.

All payments are processed by Charles Sturt University (CSU) Finance.

You will need to have submitted your completed Domestic Electronic Funds Transfer form to Equally Well prior to completing this form.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postcode
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Have you submitted my bank details via email to Equally Well?

YESNO
Unfortunately, before you can complete this form, you will need to email your completed Domestic Electronic Funds Transfer form to Equally Well at ssharpe@csu.edu.au.
List your expenses*
Total reimbursement
Please upload a copy of all your receipts*

Cancelof
By signing this form I confirm that I have incurred the above costs in relation to my travel to to attend the 2025 Equally Well conference. All expenses claimed are supported by a receipt/invoice attached. I have not and will not seek a claim for these expenses from any other source. The information I have provided it true and correct.
Signature*

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