Design Competition: Reimbursement Form
Complete this form if you need to submit a reimbursement for Design Competition related expenses. As a reminder, reimbursement requests MUST be submitted within 10 DAYS of the event or purchase in order to prevent processing delays and must include proper documentation: electronic copies of ALL receipts, invoices, etc. All reimbursement requests will be taken out of your $500 budget (per team.) Please keep in mind: reimbursements typically take 3-5 weeks to process.

For further information, please visit http://jacobsschool.ucsd.edu/events/2016/designcompetition/#resources

Questions? Email Nikki: nhsueh@eng.ucsd.edu.

Name
Your answer
Student PID
Your answer
Email Address
Your answer
Team Name
Your answer
Reimbursement Total
Your answer
Date of Purchase
MM
/
DD
/
YYYY
Description of item(s) being reimbursed
Ex: Arduino boards and LEDs purchased for Design Competition prototype
Your answer
I have received a reimbursement in the past:
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