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REIMBURSEMENT FORM FOR SMARTER BALANCED SNE WORKSHOP

Please complete the reimbursement form and attach all relevant receipts by July 25, 2025. Reimbursements will be processed within 30 days of receipt. Forms must be received by this deadline to be guaranteed payment within 30 days.

Itemized receipts are required for ALL listed expenses. Please refer to the Travel and Reimbursement FAQ document for questions regarding reimbursements and allowable expenses. 

Full Name:

Check Payable to:

Address:

Apartment, Suite, etc.:

City:

State:

ZIP/Postal Code:

Email Address:

TRANSPORTATION

Expense: Transportation from/to the airport
Amount to be disbursed ($):

Expense: Transportation from/to the airport
Amount to be disbursed ($):

Expense: Driving mileage (at $0.67/mile rate)
Amount to be disbursed ($):

Expense: Parking
Amount to be disbursed ($):

Other Expenses: please be as descriptive as possible
Amount to be disbursed ($):

TOTAL transportation expenses ($):

MEALS AND INCIDENTALS

Please note: Attendees will be reimbursed for meals and incidentals up to $79 for travel days, and for only dinner up to $35 on workshop days. Incidentals include expenses such as copy/print services, Wi-Fi, toll fees, other miscellaneous fees, and gratuity.

Meals

Please enter a list with the date, time, and amount ($) for each meal:

Meals TOTAL ($):

Incidentals

Please enter a list with the description, date, time, and amount ($) for each incidental:

Incidentals TOTAL ($):

RECEIPTS

Combine all receipts in a PDF binder and please attach the PDF here. You can also email receipts to [email protected]. Ensure the file name has your name.

To get reimbursed, all receipts must:

• Be included as a PDF.
• Be itemized, clearly showing all purchases and prices.
• Include the date of purchase.
• Be readable.

TOTAL amount ($) being submitted for reimbursement:

Thank you! Please send any questions or edits to [email protected].