REIMBURSEMENT FORM

Please note: This form will only be reviewed when it is directly related to a previously approved funding request. If no funding request has been submitted and approved, the reimbursement will not be reviewed. All reimbursements must have itemized receipts attached. Reimbursements will *NOT* exceed previously approved amounts.

If you need help with the form or wish to complete it on paper, you can email sa funding@sl.on.ca or visit the Student Association Front Desk.

Type of reimbursement*

By checking the box below the applicant confirms that all relevant guidelines - including but not limited to the funding request guidelines and the clubs guidelines where applicable - have been thoroughly read and understood before the completion of this package.

I have read and understood all relevant guidelines

Name of person seeking reimbursement*

First NameLast Name

Contact number*

Area CodePhone Number

SLC e-mail*

example@student.sl.on.ca

Name of activity being reimbursed *

This should match the name included on your request

Account Information for Direct Deposit (usually found on your online banking portal)

By filling out the account information section, you agree that this information is stored in the email inbox shared by multiple people.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Bank Institution Name (ex. CIBC, Scotiabank)*

Transit Number*

Institution Number*

Account Number*

Upload screenshot of Bank details or the Void cheque (in jpeg or pdf form)

Browse Files

Receipt details*

	Company	Description	Amount ($)
1
2
3
4
5
Total (in CAD)

Upload receipts or any other relevant files below or drop them off at the SA Front Desk

Browse Files

Reminder: All funding requests are subject to outcomes reporting to ensure the value of the funding to the user and to the wider Student Association and SLC communities. Please be prepared to report on outcomes by the date supplied during the funding request process.

Student Association Authorization (for office use only)

	Name	Title	Date
Authorized By
Authorized By

Disclaimer

To ignore any policy represented on this form, funding guidelines, and/or club policies may negatively affect the likelihood of the same group receiving requested funds in the future.

The Student Association of St. Lawrence College, Kingston Campus and the reimbursement recipients of St. Lawrence College, Kingston Campus have agreed upon the accuracy of all above information and both parties agree to adhere to the presented guidelines.

By signing this and all accompanying documents we certify that we have read the Funding Request Guidelines thoroughly and carefully and fully understand the requirements for application, reimbursement, funding allocation, and reporting on funding outcomes. We fully understand our responsibility to follow all applicable Student Association or St. Lawrence College Policies and Procedures.

*Please allow up to five business days for a response to your reimbursement*

Signature of submitter*