Student Program Reimbursement Form

1. All purchases must be approved by your Hillel staff advisor in order to be eligible for reimbursement.
2. No tax will be reimbursed. Hillel is a not-for-profit organization, and such is tax exempt. It is your responsibility to obtain a tax exempt form from the office prior to purchase.
3. You must submit receipts for all reimbursements to the Hillel office manager.
4. This form should be submitted no later than one week after the program ends.

* First Name

* Last Name

* Email Address

* Phone Number

* Address to mail reimbursement (may be a campus box #)

City

State

Zip Code

* Event Name

* Event Date

* Expense

* Amount

Expense

Amount

Expense

Amount

Expense

Amount

Scanned copy of receipts to upload (You may also send your receipts in by mail to Denise Walsh at campus box 7461 or 6300 Forsyth Blvd., St. Louis, MO 63105

* Indicates Response Required