Expense Reimbursement Request

Expense Reimbursement Request
Expense reimbursements are for personal expenses, paid for with a personal credit card, and are unrelated to travel expenses.
Examples: a local dinner with a candidate and food for departmental meetings.
Note: A guest list is required when submitting receipts for food.
Name:*
E-mail
UFID:*
Numbers only; no hyphen (-).
Expense Date:*

MonthDayYear
Event:
Account to Charge:*
Total Reimbursement Amount:*
Benefit to the State:*
Please explain what this purchase was for and/or how it will be used. *
Photo or Scan of Receipt or Program:

Upload a File

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Photo or Scan of Guest List: (Share Funds Only)

Upload a File

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Comments or Additional Information
Should be Empty: