YIRA Reimbursement Request
Name *
If requesting a check, please include the name you'd like us to use
Your answer
Email *
Your answer
Constituent Program *
Transaction Date *
MM
/
DD
/
YYYY
Amount of Reimbursement *
In USD
Your answer
Item/Service Description *
Briefly explain what you bought and why
Your answer
Preferred Reimbursement Method *
Checks will be given to program heads during YIRA Board Meetings each Sunday. Please collect your checks directly from your program head.
Venmo Username
Please include your username if you opted to receive a reimbursement via Venmo
Your answer
Receipt Submitted? *
Please upload an image or scan of your receipt here: https://goo.gl/Efvneh -- Please name the file "Name Date-of-Transaction." (e.g. "John Smith 9-23-16.jpg"). If you have multiple receipts, please put them all together in one file. YIRA reserves the right to deny reimbursement requests, particularly those that do not have accompanying receipts.
If receipt is not available, please explain
Your answer
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