SR
Date Submitted: ID Number:
I. Payee Information
Payable to SSN
Address Phone #
Address Fax #
City, State, & Zip Email Address
II. Payment Information (Required)
Business Purpose:
III. Non-travel Expenses
Supplies: Other Payment:
Materials:
IV. Reimbursement of Student Expenses
Lodging: Other Costs Incurred:
Airfare: (please describe)
Meals:
Ground Transportation:
Registration: Total Expenses Incurred:
ATTACH ORIGINAL RECEIPTS.
Index Account Activity Location Expe nses Charged Accounts Payable Use Only
$
$
$
$
$
TOTAL $
Comments:
Signature of Requestor: _________________________________________Ext____________ Date: ___________
Budget Responsible Person or Advisor Approval: ______________________________Ext____________ Date: ___________
Student Reimbursement Form
Accounts Payable - Mail #AQU 302
http://www.stthomas.edu/accountspayable
(651) 962-6375 Fax: (651) 962-6110
This form is to be used for student expense reimbursements. Attach original receipts for student expense reimbursements.
Department _______________________
Program __________________________
Requestor _________________________
Department Information:
Mail # __________
(please describe)
Total Payments Incurred:
