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C.O.P.S. Weekender Reimbursement Submission Form

PURPOSE: This form is for eligible attendees to submit documentation requesting reimbursement for approved flight expenses related to attendance at a C.O.P.S. Weekender or designated C.O.P.S. program.

IMPORTANT: All required receipts and reimbursement documentation must be submitted within 90 days of attendance.

Section 1 — Attendee Information

Full Name

Email Address

We will use this email address if additional information or documentation is needed.

Phone Number

Reimbursement Mailing Address

Street Address

Address Line 2

City

State

ZIP Code

Please provide the address where you would like reimbursement sent.

Section 2 — Fallen Officer Information

Fallen Officer First Name

Fallen Officer Last Name

Officer’s End of Watch

Section 3 — Weekender Information

Which Weekender or C.O.P.S. program did you attend?

Attendance Start Date

Attendance End Date

Section 4 — Flight Reimbursement

Flight Amount Requested for Reimbursement

Enter the amount of approved flight expenses you are requesting for reimbursement.

Upload Flight Receipt / Itinerary

Please upload documentation showing the traveler’s name, flight itinerary, and amount actually paid.

Upload Proof of Payment

Upload proof of payment only if payment information is not shown on the flight receipt or itinerary.

Section 5 — Reimbursement Requirements

Please review before submitting:

• C.O.P.S. reimbursement covers approved flight expenses only.
• C.O.P.S. does not reimburse airline upgrades, upgraded seating, Uber, Lyft, or other rideshare expenses.
• Attendance at the Weekender must be verified before reimbursement will be issued.
• All required receipts and reimbursement documentation must be submitted within 90 days of attendance.
• Submission of this form does not guarantee reimbursement. Reimbursement is subject to verification and applicable C.O.P.S. reimbursement guidelines.

Reimbursement Requirements Acknowledgment

Section 6 — Certification and Signature

Electronic Signature

By entering your full name, you certify that the information provided in this reimbursement request is accurate.

Date Submitted

Please review your information and uploaded documentation carefully before submitting your request. C.O.P.S. Arizona may contact you if additional information is required.