Reimbursement Request Form - Fund For Education Abroad (Page 2 of 2) in pdf

Reimbursement Request Form - Fund For Education Abroad Page 2

Fund for Education Abroad Check Request Form

☐ Request payment to school/program

☐Request reimbursement to Scholar

Scholar’s Name: _______________________________________________________________________

Date requested: _____________________________ PAYMENT DUE DATE: ________________________

Make Payable to: ______________________________________________________________________

Mailing address for check (school or program address for direct payments, home address for scholar

reimbursement):

_____________________________________________________________________________________

Special Instructions (anything in the memo line?):

____________________________________________________________________

Provide total costs in the table below, reflected on your bills or receipts. Then, in the spaces below the

table, please provide the actual pay / reimbursement amount based on your scholarship award.

Receipt/Invoice

Description of expense

Amount in

Amount in US

number (if available)

foreign currency

dollars

(if applicable)

Total

Actual amount to be paid to institution or program: __________________________________________

Actual amount to be reimbursed to scholar: _________________________________________________

If you need a wire, please email

to coordinate.

Reimbursement Request Form - Fund For Education Abroad Page 2