Volunteer Reimbursement Form
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3Volunteer Reimbursement Form
For AA Staff use-
Name & Class:
Staff Approved Signature:
Address:
Account #/Dept:
/
Event:
Received/Approved Dates:
/
Event Date:
Print Form
Reset Form
Reimbursement Expenses:
Electronic form will automatically tally daily totals and expense total for your report. For plane tickets, use return date. For hotels, daily expense should
include taxes and fees for that day. Meals should include tip. Other gratuities are baggage tips, maid service, etc.
Item
Notes
Date
Date
Date
Date
Date
Enter Amount Enter Amount
Enter Amount
Enter Amount
Enter Amount
Breakfast
Lunch
Dinner
Note: per diem meals maximum = $75
Hotel Room
(incl. room + taxes + fees per night)
Plane Tickets
Ground Transportation - Hired
(rental,shuttle,bus,train,limo,taxi)
Mileage
Miles x $0.535
Put mileage on top cell
$
$
$
$
$
Parking
Tolls
Gratuities (explain in notes)
Other (explain in notes)
Expense Total
Daily Totals:
$
$
$
$
$
$
Reimbursement Options
Check
Fill in $ Amount
Please check (X) one option and fill in $ __ amount)
Option
Reimburse me the total reimbursable expenses.
$
Reimbursement
Send me no reimbursement. (Please complete and attach Form A. A copy of this report and a signed
Requires Form
N/A
copy of Form A will be sent to you for tax purposes.)
A
Credit the Alumnae Association's Founder's Fund with the net amount as a donation.
$
Founder's Fund
Credit the Alumnae Association's Founder's Fund for amount shown as a donation in my name and send
$
Founder's Fund
remainder to me as partial reimbursement
$
Reimbursement
Credit the Mount Holyoke Fund with the net amount as a donation.
$
Mt Holyoke Fund
Credit the Mount Holyoke Fund for amount shown as a donation in my name
$
Mt Holyoke Fund
and the remainder to me as partial reimbursement.
$
Reimbursement
Credit the Alumnae Association's Founder's Fund for amount shown as donation in my name
$
Founder's Fund
and credit the Mount Holyoke Fund for amount shown as donation in my name
and send the remainder to me as partial reimbursement.
$
Mt Holyoke Fund
$
Reimbursement
Signature:
Today's Date:
Send this form with receipts within 30 days of event. If sending materials electronically, please be sure your receipts are legible! If sending via USPS, please
sign and mail along with all original receipts To: [your liaison], Alumnae Association of Mount Holyoke College, Mary Woolley Hall, 50 College Street, South
Hadley, MA 01075-1486
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