NACDA U Reimbursement Form

NACDA U Expense Reimbursement Form
Please note, due to auditing reasons, reimbursements for the NACDA U Program can only be made payable to the institution. They cannot be reimbursed directly to the individual.
NACDA U Recipient Name:*

First NameLast Name
Institution/Affiliation:*
Title:*
Recipient email address:*
example@example.com
Cell Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Please select one:*

Institution - ACHInstitution - Check
If you answered Institution - ACH to the above question, please list an individual, along with their email address, who would be responsible for providing ACH remittance detail for payment to be made back to the university.
Name of Individual in Business Office (ACH Payment)

First NameLast Name
Email of Individual in Business Office (ACH Payment)
example@example.com
If you answered Institution - Check to the above question, please add in the address of where the check should be sent and to whom.
Name of Individual who the check should be sent to*

First NameLast Name
Email of individual check will be sent to*
example@example.com
Address (Check Payment)*

Street Address

Street Address Line 2

CityState

Zip Code
Name of Event/Meeting*
Dates:*
MEETING EXPENSES
Please only complete expenses for the items for which you are requesting reimbursement. Not all fields need to be completed in order to submit the form, but corresponding receipts for expenses are required.

Total expenses will auto-calculate at the end of the form.
Round Trip Auto Transportation (Rate: 70 cents per mile / mileage not to exceed price of coach airfare)
To destination city from city of origination for total miles traveled total miles.
Mileage total:
Auto-calculated based upon total miles traveled.
Airfare total (coach fare only):
Please enter value in currency format.
Please attach airfare receipt:*

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Per diem ($30/day; 2 day maximum):
Please enter value in currency format.
Lodging total:
Please enter value in currency format.
Please attach lodging receipt:*

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Parking total:
Please enter value in currency format.
Please attach parking receipt:*

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Rental Car total:
Please enter value in currency format.
Please attach rental car receipt:*

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Registration total:
Please enter value in currency format.
Other Expenses:
Please enter value in currency format.
Please attach all corresponding receipts:*

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Additional notes related to the reimbursement:
TOTAL EXPENSES:
Auto-calculated based upon previous entries.
Should be Empty: