Fillable Reqfor Reimbursement (Santa Barbara City College)

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Reqfor Reimbursement (Santa Barbara City College)

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5/5/2017
SANTA BARBARA CITY COLLEGE
721 CLIFF DRIVE, SANTA BARBARA, CALIFORNIA 93109-2394
Carlene Barrows (805) 965-0581 x2565/Renee Collins (805) 965-0581 x5195
REQUEST FOR REIMBURSEMENT
This form is to be used when requested Reimbursement for Purchases, Meal Advances and Field Trips. Please do not
use this form to request a Travel and Conference reimbursement, an Invoice to be paid, or a Scholarship Transfer to
another institution.
District Reimbursement
Trust / Auxiliary / Financial Aid Reimbursement
Check Payable To :
K Number :
Mailing Address :
Email:
@pipeline.sbcc.edu
Amount
:
$
to be Paid
Budget
Account
Number
Amount:
__ __ __ __ __ __ - __ __ __ __ - __ __ __ __ __ __ - __ __ __ __ __ __ - __ __ __ __ __ __ _______________
FUND # ORG # ACCOUNT # PROG # ACTIVITY # (if applicable) Budget#1
__ __ __ __ __ __ - __ __ __ __ - __ __ __ __ __ __ - __ __ __ __ __ __ - __ __ __ __ __ __ _______________
FUND # ORG # ACCOUNT # PROG # ACTIVITY # (if applicable) Budget #2
Description
of Purchases for
Reimbursements,
Meal Advances* and
Field Trips
*Meal Advances: Include Travel
Dates, Destination, Student
Count (Trust/Auxiliary/Financial
Aid Accounts Only)
Payment Method
Check to be picked up in Accounting Office, A-130 (Trust/Auxiliary/Financial Aid Accounts Only)
(select one)
Check to be mailed to mailing address listed above
Direct Deposit * Student Setup completed by Student in Pipeline. Prior to Submitting Request.
* Employee Direct Deposit form must be filed with Accounting. Prior to Submitting Request.
* Vendor Direct Deposit Setup per Vendor Instructions
Receipts / Invoices
Original Included with Form (Required)
Other ___________________________________________________________
I certify that the expenditure(s) above are in accordance with The District’s regulations and purpose of this Fund and Account, and the person stated
above is submitting the attached receipts for reimbursement
.
(Trust & Auxiliary Funds Require TWO authorized signatures.)
Signature of Person
to be Reimbursed:
Date:
Authorized Account Signer #1
Date
Authorized Account Signer #2 (Trust Only)
Date
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0.00
✔
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Completed 19 July 2020

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