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/Committee/Section committee:___________________________________________
Purpose of the expense:_______________________________________________________
Itemized expenses:
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Date
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Item
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Amount
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Budget Line Charge
(ACRL office use only)
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Total: $ |
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_____ 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: |
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Approved by: ________________________________________________________
Chapter/Committee/Section committee Chairperson
Date: |
Send completed form and original receipts to:
Reimbursement Request
ACRL/ALA
50 East Huron Street
Chicago, IL 60611-2795
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