All Reimbursement Forms 

  • Name/Address should be filled out
  • Must be signed by hand
  • Must be dated 



Non-Travel Related Expenses

Insurance

  • Must list dates or months
    • If on a payroll insurance, should list the dates of payroll period: (i.e. 12/5-16/22) 
    • If on an individual plan, should list the dates or month/year: (i.e. 12/1-31/22 or Dec 2022) 


Insurance not paid through a company plan (i.e. you receive your insurance through the Health Exchange) 

  • Documentation of Insurance Period (1 of the following)
    • Billing Statement OR
    • Printed Image from online healthcare account showing billing period   OR 
    • Email reminder with autodraft details 

AND

  • Documentation of Payment (1 of the following) 
    • Cashed check image (must have front and back image)  OR
    • Line item from banking or credit institution that shows processed payment    OR
    • Confirmation Email from healthcare provider    OR 
    • Printed image from online healthcare account showing the payment receipts 



Insurance paid through Payroll Deductions 

  • all pay stubs required for reimbursement periods 



Travel-Related Expenses


  • Per Diem Should be filled out according to departure and arrival times 
  • Itemized Hotel bill 
  • Flight receipt, flight estimate, and itenerary if booked on their own or if alternate travel 
  • Documentation of Mileage required (map)
  • Registration receipt (if claimed) 
  • Any non-meal receipts over $50.99
  • Proof of attendance 
    • Copy of Nametag
    • Copy of Agenda
    • Copy of Cover
    • Hotel folio
    • Receipt from conference city  


Local Travel – travel within 50 miles of home or host site 

  • All receipts required 
  • Per diem allowance based upon meeting time and per diem for location