Reimbursement Request Form 2016-2017
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Reimbursement Request Form
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Submit this form via email to Hikari Oshiro - hoshiro@stonybrookusg.org
****Please note that you MUST receive a confirmation email in order for the
reimbursement to be approved. Turning in the form alone does nto make you eligible for
reimbursement.
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Name of Requestor:
Katherine Tsui
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Contact Information:
katherine.tsui@stonybrook.edu
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Position in Club:Treasurer
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Club Name:Cantonese CLub
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Person being
Reimbursed:
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Items:
Description and
Justification:
Number of
items:
Unit cost of
items:
Total:
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MTA Bridges and Tunnels Throgs Neck Bridge
Rented 3 cars to go to a competition, and had to pay for toll to the competition and back
4832
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MTA Bridges and Tunnels Robert F Kennedy Bridge Bronx Plaza
Rented 3 cars to go to a competition, and had to pay for toll
188
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MTA Bridges and Tunnels Bronx Whitestone Bridge
Rented 3 cars to go to a competition, and had to pay for toll
188
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Total Cost:$48.00
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Event Date:3/3
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Event Title
(GBM/Event/etc.):
BOOM Dance Competition
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For USG Treasurer:
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Date Completed Application was Received:
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Additional Documents Received:
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Approval Status:Date Approval:
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Approval Signature:
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Reimbursement Request Form