Reimbursement Request Form
Prior to submitting this form, please review the Society's Travel Reimbursement Flow Chart at http://adps.org/documents/2015/11/travel-reimbursement-flow-chart.pdf

If you have any questions, please email the Society Treasurer at treasurer@adps.org.

Name *
Your answer
Chapter *
Your answer
Graduation Year *
Your answer
Email Address *
Your answer
Preferred Reimbursement Option *
PayPal is our preferred option, but you must have a PayPal account.
Address (if requesting a Check), or PayPal email (if requesting PayPal reimbursement) *
For addresses, include your zipcode
Your answer
Purpose of Expenses *
(e.g., Interchapter Travel, Convention, Caucus, etc.)
Your answer
Itemized Description of Expenses *
(Please include date and amount for each item.) The Society reimburses travel in the actual amount spent (e.g., gas and tolls). If you do not have gas receipts, you may request reimbursement at 14 cents per mile, the IRS standard for charitable organizations.
Your answer
Total Amount Spent *
Your answer
Total Amount Contributed *
(zero if requesting full reimbursement)
Your answer
Total Amount Requested for Reimbursement *
(Travel by public transportation is only reimbursable when pre-approved)
Your answer
Have You Emailed Your Receipts To Headquarters ? *
If you have any receipts, please email them to HQ@adps.org
Submit
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