FUND REIMBURSEMENT FORM
RESIDENCE LIFE – UNIVERSITY OF PUGET SOUND
Receipts required. No cash advances.
Complete and turn in this form to your supervisor for approval. Residence Life office will contact you
when your cash reimbursement is available. Large dollar amount requests may be sent to Accounts
Payable for reimbursement by check.
Name: __________________________________________ ID#: ________________ CMB#__________
RA
House RCC
TRM/NRH RCC
GHC
Resident
E-mail:_____________________________________________Cell Phone: ________________________
Residence Hall or House area: ____________________________________________________________
Event/Function:
 Brief Description_________________________________________________________________
 Date _____________________
 Location _______________________________________________________________________
 Attendees (hall residents, staff, campus community, public / approx. numbers) _____________
______________________________________________________________________________
Items or Services Purchased
Vendor
Price
Total:
Total Amount Requested:
I accept full responsibility for the sum of money noted above. I realize that I must attach
receipts to this form to account for all monies for which I am requesting reimbursement.
_________________________________________________________ Date: _____________
(Signature of student requesting reimbursement)
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For Pro-Staff Use:
Speed Chart OR Project Number
Account
Chartfield1
Supervisor Approval:
Date:
Budget Manager Approval:
Date:
CASH Reimbursement RECEIVED:
_________________________________________________________ Date: ___________________