Reimbursement Request for
Career Development
AFTER
EXPENSES & TRAVEL ARE COMPLETED
This form is only for Trainees in the Atlanta BEST Program.
Last name:
*
First name :
*
EMAIL:
*
Address where you want the check sent to:
Street
*
City, State, Zip
*
What is this request for?
Type of Purchase ~Select all that apply
*
Conference Registration
Book/Literature
Airfare
Mileage (will need a map w/miles attached)
Lodging
Meal(s)
Registration fee
Informational Interview Expense: Lunch, coffee, etc Describe below
Business Cards
Other
Additional Comments, if needed
Location: Organization, City, State
*
Start Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
List out your budget in US Dollars.
YOU MUST FOLLOW THE RECEIPT REQUIREMENTS LISTS
HERE
TO GET FULLY REIMBURSED
Total Budget Requested:
*
Misc Fee:
Airfare:
Mileage ($0.575/mile) must attach map w/mileage
Number of Miles
Starting location City
Ending location City
Lodging:
Number of lodging nights
Meals Total: (subtract out alcohol)
Other budget amount:
Describe:
Please attach all relevant documentation in one PDF (i.e. itinerary, website pages, invoice, etc)
Attachment:
*
Select File
Cancel
of
Attachment #2 if needed:
Select File
Cancel
of
Describe Attachment
*
For the following answers, please fully describe, be specific and give examples.
Statement: How helpful was the activity to clarify or inspire a future career path you may be interested in?
*
Statement: Would you recommend it?
*
Additional comments
Submit
Should be Empty: