Health Professions
Scholarship Program (HPSP)
How To Submit A Reimbursement
Army
Steps for completing reimbursement
• Print off the Medcom Form 678-R found at
http://www.atsu.edu/registrar/military.htm
• Fill in the top section with the student and
institution information
• If claiming Health Insurance, Vaccinations,
USMLE fees, and Eras Fees complete Item 12
with dates claimed and cost
• Enter total
Army
Steps for completing reimbursement
• Enter Required Textbooks/ Author, Equipment
and Supplies in Item 13
• Enter Date of Purchase and Cost in appropriate
columns
• Add up sales tax and enter on Total Taxes for
Item 13 Line
• Add total of books to sales tax and enter in the
Total column for Item 13
• Enter Grand Total Items for 12 and 13
• Sign the form
Army
Steps for completing reimbursement
• Attach your receipts with the form. If using small
receipts from the bookstore please tape them
to a blank sheet of white paper. You do not
need to include the actual credit card processing
receipt.
• Deliver, mail, or fax to the Record’s Coordinator in
the Registrar’s Office.
• We will check forms to make sure it contains only
reimbursable items, sign and forward to the Army
for reimbursement.
• Please make copies of all forms and receipts for your
records.
Navy
Steps for completing reimbursement
• Print off the Dean’s Certificate and Standard Form 1164 found
at http://www.atsu.edu/registrar/military.htm
• Complete student and university information at the top of the
Dean’s Certificate. We will complete the rest of that form.
• On Standard Form 1164, complete the top portion for the
Claimant information
• Enter all expenditures in the expenditure portion of the form.
Enter date (A), items you are claiming in the C and D columns
and enter the cost in the Mileage (F) column.
• If needed, continue on back of form and carry totals over to
the front in the Subtotals Carried Forward from the Back
column.
Navy
Steps for completing reimbursement
• Enter sales tax and label it on one of the lines.
• Enter total amount claimed on line 7 Amount
Claimed.
• Sign and date the form in section 10.
Navy
Steps for completing reimbursement
• Attach your receipts with the form. If using small
receipts from the bookstore please tape them
to a blank sheet of white paper. You do not
need to include the actual credit card processing
receipt.
• Deliver, mail, or fax to Record’s Coordinator in the
Registrar’s Office.
• We will check forms to make sure it contains only
reimbursable items, sign and forward to the Navy
for reimbursement.
• Please make copies of all forms and receipts for your
records.
Air Force
Steps for completing reimbursement
• Print off the AFIT Form 31 found at
http://www.atsu.edu/registrar/military.htm
• Complete form and forward to the Air Force. Air
Force students do not turn anything into the
Registrar’s Office and their forms do not require
the Registrar’s signature (Navy & Army do).
Please remember the following tips:
• Please submit health insurance for
reimbursement each time the premium is
paid.
• Only items for reimbursement should be
included on receipts submitted with
reimbursement form. Purchase other nonreimbursable items in a separate
transaction.
• Forms can be found at
http://www.atsu.edu/registrar/military.htm
Registrar’s Office Contact
Information
• Laura Brummitt- Records Coordinator
▫ Processes all HPSP Reimbursement Claims
ATSU
Office of the Registrar
800 W. Jefferson Street
Kirksville, MO 63501
Phone 660.626.2356
Fax 660.626.2926
lbrummitt@atsu.edu
registrars@atsu.edu