ASI Safe Rides Reimbursement Request Form
This form closes after Finals Week of Spring Semester 2026.
Are your receipt dates between January 26th and May 17th, 2026?
*
Yes
No
Name
*
OneCard #
*
Physical OneCard
*
Upload
ASI Safe Rides is for currently enrolled Sac State students.
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Contact Info
In case we need to follow up with you about your request. This allows us to quickly process reimbursements and update you on your status.
Sac State Email
*
Confirmation Email
Verify that the emails match.
Phone #
*
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Examples of Approved Receipts
Uber/Lyft Rides
Amtrak
DMV & Vehicle Inspections*
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Receipts
Step 2: Upload receipts and verify information.
Multiple uploads allowed. We highly recommend uploading the Uber/Lyft receipt sent to your email, not the screenshot from the app.
Upload Uber/Lyft Receipts only
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Multiple uploads allowed. We highly recommend uploading the Amtrak receipt sent to your email.
Upload Amtrak Receipts only
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Multiple uploads allowed. *Bank statement required.
Upload DMV Receipts and Bank Statement only
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Examples of Approved Payments
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Proof of Payment
Step 3
Upload a picture of the credit card you used to pay.
Front of Credit Card - please cover the first 12 digits and leave the last 4 showing.
Upload
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Back of Credit Card - please cover the first 12 digits and leave the last 4 showing.
Upload
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The last 4 digits of my card match the last 4 digits on my receipt.
Yes, they do.
No, they do not. I will need to upload a copy of my bank statement.
Apple Pay, Google Pay, and Zelle payments will require a bank statement that matches your receipt amount and timestamp.
Upload Bank Statement
Reimbursements without this verification will be denied.
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Mailing Address for Check
Step 4
Include your apartment/room/dorm/unit number.
Please complete this section carefully.
Mailing Address
Apartment, dorm, room, unit #
City
State / Province
Postal / Zip Code
Is this the same address you will be living at after Spring Semester 2026?
*
Yes, please mail my check to this address.
No, I plan to move after Spring Semester 2026. I will enter my permanent home address below.
Permanent Address (optional)
Mailing Address
Apartment, dorm, room, unit #
City
State / Province
Postal / Zip Code
I have submitted true and accurate information.
*
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