SCOMSA REIMBURSEMENT FORM A
Please read instructions listed on before submitting this form.
Incomplete forms will not be accepted. Reimbursements must be requested within 30 days of event.
PLEASE SEE PAGE 2 FOR MORE INFORMATION.
Student Organization
Individual Funding
National Conference
Funding Type:
Organization name: __________________________________________________________
Student name: ______________________________________________________________
Event Title:
_______________________________________________________________
Event Date:
_________________
TOTAL COST: $______________________
SCOMSA Reimbursement Amount: _________________________________
Other Source of Funding & Amount: _________________________________
Other Source of Funding & Amount: _________________________________
Payee information
Name (make check payable to): __________________________________________
BU ID: ______________________
Email: ____________________________
Mailing Address:
_____________________________________________________
_________________________________________________
_________________________________________________
Authorization
I have read and understand the guidelines listed on this form and online at:
_______________________
_________________________
________________
Payee Name (please print)
Signature
Date
Payment Approved and Account Authorized by:
Christina Snyder
_______________________
_________________________
________________
SCOMSA Treasurer
Signature
Date