Fillable AIR FORCE HEALTH PROFESSIONS SCHOLARSHIP PROGRAM (AFHPSP) REQUIRED (Air Force Institute of Technology)

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AIR FORCE HEALTH PROFESSIONS SCHOLARSHIP PROGRAM (AFHPSP) REQUIRED (Air Force Institute of Technology)

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AIR FORCE HEALTH PROFESSIONS SCHOLARSHIP PROGRAM (AFHPSP)
REQUIRED REIMBURSEMENT(S) ACCOUNTING LIST
PRIVACY ACT STATEMENT
AUTHORITY: 10 USC 8012, Sec of the AF, Powers & Duties, Delegation by Compensation; EO 9397, 22 Nov 43, Numbering System for
Federal Accounts Relating to individual Persons. PRINCIPAL PURPOSES: Provide HPSP students with consolidated form to list itemized
expenditures and certification for reimbursement. SSN required for identification. ROUTINE USE: Listing itemizes expenditures and expedites
handling of claims. DISCLOSURE IS VOLUNTARY. Students requested to use form for standardization.
NAME (Please print or type last name, first name, middle initial) SSN PHONE (Include Area Code)
CURRENT ADDRESS (Include Street, State, and Zip
Code)
SCHOOL
AFIT FORM 31, 20010315 (EF-V1) PREVIOUS EDITIONS ARE OBSOLETE
FOR AFIT USE ONLY
REQUIRED ITEMS
(Insurance, book title, equip, boards)
DEGREE PROGRAM
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AFHPSP ELIGIBILITY DATE
GRADUATION DATE
CODE REASON RESUBMITTALALLOWED
TOTAL
COST
UNIT
COST
QTY
COURSE
NUMBER AND
DESCRIPTION
E-MAIL ADDRESS
IMPORTANT: You will not be able to save the edited version of the form in Adobe Acrobat Reader. Please print the form and review it carefully for errors 
before going on to the next form or exiting from the program. [If you have the full version of Adobe Acrobat (not the free Acrobat Reader), you will be able 
to save your edited form on your computer.]
SIGNATURE OF STUDENT
NAME (Please print or type last name, first name, middle initial)
FOR AFIT USE ONLY
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AFIT FORM 31, 20010315 (REVERSE) (EF-V1)
DATE
I certify that this claim for reimbursement is for items that are required and actually used for academic/clinical
attendance by myself and all other students at this institution pursuing a like degree during the current academic
period (Starting Ending ). I also understand that tuition
and related fees, textbooks, supplies, and equipment required for postgraduate education programs beyond
AFHPSP are nonreimbursable. I certify all required documents to support this reimbursement are attached.
CODE REASON RESUBMITTAL
REQUIRED ITEMS
(Insurance, book title, equip, boards)
UNIT
COST
ALLOWED
TOTAL
COST
QTY
COURSE
NUMBER AND
DESCRIPTION
SUBTOTAL
+TAX
TOTAL
SUBTOTAL
+TAX
TOTAL
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AIR FORCE HEALTH PROFESSIONS SCHOLARSHIP PROGRAM (AFHPSP) REQUIRED (Air Force Institute of Technology)

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Completed 27 September 2021

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