ASI Safe Rides Reimbursement Request Form
Only rideshares, smog checks, and REAL ID renewals after 8/30/2026 are eligible. (Ex: Monday, August 31st and onwards)
Refer to ASI Safe Rides Policy #01.
Name
*
OneCard #
*
Physical OneCard
*
Upload
ASI Safe Rides is for currently enrolled Sac State students.
Cancel
of
Contact Info
Sac State Email
*
Confirmation Email
Verify that the emails match.
Phone #
*
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Next
Visual Guide
Example Uber Receipt
Example Lyft Receipt
Example Denied Receipt
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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of
Multiple uploads allowed. We highly recommend uploading the Amtrak receipt sent to your email.
Upload Amtrak Receipts only
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of
Multiple uploads allowed. *Bank statement required.
Upload DMV Receipts and Bank Statement only
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of
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Next
Upload a picture of the credit card you used for the transaction(s).
Front of Credit Card(s) - please cover the first 12 digits and leave the last 4 showing.
Upload
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of
Back of Credit Card(s) - please cover the first 12 digits and leave the last 4 showing.
Upload
Cancel
of
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Next
Mailing Address for Reimbursement 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 Fall Semester?
*
Yes, please mail my check to this address.
No, I plan to move after Fall Semester. I will enter my permanent home address below.
Permanent Address
*
Mailing Address
Apartment, dorm, room, unit #
City
State / Province
Postal / Zip Code
I have submitted true and accurate information.
*
Current Date and Time
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Year
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Submit
Should be Empty: