Please submit your reimbursement receipts and documentation via this form. If you have any questions regarding documentation or travel please contact Joshua via email. ReUSE Final Reimbursement First, Last Name * Email * Mailing Address (this should be where you want your reimbursement check sent) * Mailing Address (this should be where you want your reimbursement check sent) Street Address Street Address Apartment/Unit Number Apartment/Unit Number City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Travel Reimbursement Request Please check all items that apply for which you're seeking reimbursement. Documentation/receipts are needed for each item and can be uploaded in one of the following sections below. Check all that apply * Personal car mileage from University of Utah to residence Personal car mileage from airport to residence Ride Share/Taxi Service (transportation to/from airports) Luggage & Additional Airfare Fees Gas Receipts (only allowable for travel between the University of Utah to your residence) Hotel Accommodations (only allowable for those who traveled between the University of Utah to your residence) Personal Car Mileage Mileage is reimbursable for trips between the University of Utah and your residence or between the airport and your residence or the University of Utah depending on your direction of travel. Documentation for this request is needed in the form of a map showing the path between destinations. Please upload this documentation below. Mileage Reimbursement is for (select one) Mileage from the University of Utah to residence Mileage from the airport to residence/University of Utah Requested Mileage Upload map(s) here showing routes between destinations Drop a file here or click to upload (JPG, PNG, PDF ONLY) Choose File Maximum upload size: 51.2MB Ride Share/Taxi Receipts Please scan or "print as a PDF" your receipts for ride share or taxi rides between the airport and your residence or the University of Utah below. Upload your ride share/taxi receipts here Drop a file here or click to upload (JPG, PNG, PDF ONLY) Choose File Maximum upload size: 51.2MB Luggage/Additional Airfare Fees Baggage fees are reimburseable for those flying between destinations. Documentation for this request is needed in the form of a receipt showing the charge and payment. Please upload this documentation below. Upload your luggage/additional airfare receipts here Drop a file here or click to upload (JPG, PNG, PDF ONLY) Choose File Maximum upload size: 51.2MB Gas Receipts Gas receipts are allowable between the airport to your residence if the distance is greater than 100 miles. Please scan or "print as a PDF" your receipts for gas below. Upload your gas receipts here Drop a file here or click to upload (JPG, PNG, PDF ONLY) Choose File Maximum upload size: 51.2MB Hotel Accommodations If you are driving to/from your residence and the University of Utah outside of the state of Utah, the ReUSE program will cover one night at a hotel during your travel. Any purchases outside of the basic room rate will need to be covered by the traveler. Please scan or "print as a PDF" your receipts for your hotel stay below. Upload your hotel receipt here Drop a file here or click to upload (JPG, PNG, PDF ONLY) Choose File Maximum upload size: 51.2MB * I verify that all the information provided is correct and I request to be reimbursed for these expenses as allowed by the ReUSE program and University of Utah. Submit If you are human, leave this field blank.
