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Chapter Reimbursement Request

Prepare original and one copy of this form. Attach original receipts such as airline ticket stubs, hotel bills, invoices, etc. to the form. A request for an honorarium must include the person's social security number.

ACRL fiscal year runs from September 1 to August 31. All requests for payment must be submitted before August 15 of the current fiscal year.

Chapter:___________________________________________

Purpose of the expense*:_______________________________________________________

*ACRL Chapters may spend budgeted resources on any items or activities that support the charitable and educational purposes of ACRL's strategic goals as identified in the strategic plan with two exceptions. 1) The alotted funds may not be used for payment of honoraria or travel to support librarians' presentations at ALA, ACRL, or ACRL chapter conferences and 2) The alotted funds may not be used to purchase goods or services prohibited by ALA and ACRL policy. —Source: ACRL Board, April 2006

Itemized expenses:

Date	Item	Amount	Budget Line Charge (ACRL office use only)





		Total: $

_____ Please check if original receipts could not be included, and state reason.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Make check payable to:________________________________________________________

Send check to:

Name:
Address:
City, State, Zip:
e-mail:
I confirm that this expense qualifies as an educational or charitable expense under Section 501(c)3 of the Internal Revenue Code. Approved by: ________________________________________________________ Chapter Chairperson Date:

Send completed form and original receipts to:
Reimbursement Request
ACRL/ALA
50 East Huron Street
Chicago, IL 60611-2795

ACRL is a division of the American Library Association