WASHINGTON ACADEMY OF FAMILY PHYSICIANS FOUNDATION
Select Campus: UW-Seattle
MEDICAL STUDENT RURAL/UNDERSERVED ACTIVITES: Student Scholar Travel
PNWU-Yakima
UW-Spokane
ATSU-Renton
Name: __________________________________________________ For Dates: _____________________________________________________
Description of Travel: ____________________________________________________________________________________________________
Location: _______________________________________________________________________________________________________________
Name(s) of Physician Preceptor: ___________________________________________________________________________________________
EXPENSE
Lunch, Dinner
Supplies
Mileage #miles at
57.5¢ per mile
Day: _________
Date: ________
Day: _________
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# miles: ______
$_____________
# miles: ______
$ ____________
# miles: ______
$ ____________
# miles: ______
$ ____________
# miles: ______
$ ____________
# miles: ______
$ ____________
# miles: ______
$ ____________
TOTALS
Ferry Fee
Lodging
Parking
Misc. (please
Itemize)
Daily
TOTALS
*CHECK ADDRESS (associated with name): ______________________________________________________________________________
*MAIL TO ADDRESS (if different than check): ____________________________________________________________________________
________________________________________________________________________________________________________________________
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Mileage: Auto mileage at 57.5¢ per mile reimbursable. Please attach Map Quest indicating mileage.
Send expense reports, backup statements and original receipts to Executive Vice President, WAFP, 1239 – 120th Avenue NE, Suite G, Bellevue, WA 98005.
Or scan and email to WAFP staff at info@wafp.net.
Do you have questions? Call 800-621-8424 or 425-747-3100
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WAFP TRUST EXPENSE REPORT: TRUST Scholar Travel Instructions and Mailing Contact Information
SEATTLE CAMPUS: Updated 2/19/2015
This is an instructional sheet, do not email or mail in this sheet.
Note: if you need a photocopy machine or scanner please stop by WWAMI offices in HSB and any of the WWAMI staff can help with
these services.
Step-by-step:
1.
2.
Complete page one.
3.
Attach Lodging Receipt (if applicable): receipt required and must be pre-approved by your regional office prior to travel. Please note you need to ensure
you have an itemized lodging receipt with an explanation of charges. A credit card slip is NOT sufficient.
4.
Scan/email OR mail (if you do not have access to email/scanner) page one and mileage documentation to:
Attach Mileage: ROUND-TRIP Google Maps Documentation (Note: Start Address must be from the Seattle Campus:
1959 NE Pacific St, Seattle, WA 98195).
A.
EMAIL:
To:
Jessica Solberg (WAFP Office & Event Coordinator, Student & Resident Liaison): Jessica@wafp.net
CC:
Michelle Pelt (Program Operations Administrator, WWA WWAMI Regional Office): peltm@uw.edu
Subject: WAFP TRUST ER (YOUR TRAVEL DATES): YOUR TRUST SITE
Sample Subject Title: WAFP TRUST ER (7/3 – 7/4/2013): Chelan
Rename scanned documentation: YOUR LAST NAME_First Day of Travel (YearMonthDay)_TRUST Site
Sample Scan Title: SMITH_20130703_TRUSTChelan
MAIL:
B.
Executive Vice President, WAFP
1239 – 120th Avenue NE, Suite G,
Bellevue, WA 98005
Mail a copy to:
Michelle Pelt
WWA WWAMI Regional Office
112 East Broadway Avenue
Montesano, WA 98563
5.
6.
7.
The WAFP Foundation will process your travel reimbursement request. Washington TRUST Student travel is sponsored by the Washington Academy of
Family Physicians (WAFP) Foundation. You will receive a check from the WAFP Foundation, mailed to the address you specify on page one of this invoice.
DEADLINE: Please submit your mileage within 30 days after your travel is complete.
Allow three weeks processing time, this is important if it is the end of the year and/or you are moving. We want to make sure a current address is available
for WAFP, so your check is sent to the correct address.
To learn more about the WAFP and opportunities available to you then please visit the WAFP student website at:
http://www.wafp.net/programs/Students.aspx
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