Reimbursement Request

http://www.ala.org/ala/mgrps/divs/acrl/resources/forms/reimbursement.cfm

Prepare original and one copy of this Reimbursement Request form. Attach original receipts such as airline ticket stubs, hotel bills, invoices, etc. to the form.

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:

 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:

 

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