HMA Reimbursement & Upfront Check Request
Use this form to request reimbursement for PRE-APPROVED expenses and check requests related to HMA supported activities. Our treasurer will review the request and respond in a few days. Please email us at with any questions.
Name of person submitting the request *
Your answer
Email address of person submitting request: *
Your answer
Is this a reimbursement request or upfront check request? *
If this is an upfront check, when do you need it?
Please give us 1 week notice if you need the check upfront if possible.
Reason for Reimbursement or Upfront Check *
What event, activity or program is the reimbursement or upfront check for?
Your answer
Which HMA fund should this be allocated to? *
Your answer
Check payable to: *
Who do you want the check made out to?
Your answer
Reimbursement amount: *
How much is the reimbursement request for?
Your answer
Mailing Address for check: *
Full address
Your answer
Have you emailed your receipt to *
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