Senior Design Personal Reimbursement Request

This form is ONLY for Senior Design students

Student Last Name

This MUST be your legal name

Student First Name

This MUST be your legal name

Student Email Address

Employee/ Student ID #

Full Home Address:(street)

The Address MUST match what is in your Mypack Portal!

City, State and Zip

Amount requested for reimbursement

Account number to be charged

Detailed Business purpose justification

Please select the correct option

This will direct the approval to the appropriate faculty member.

Building where items are housed on NCSU campus

Room # where items are housed on NCSU campus

File Upload

File upload of itemized receipt. Senior design must upload receipts and spreadsheet as one PDF. A link to a shared drive is not acceptable. Failure to upload proper documentation will delay reimbursement.

Drop your files here

Assigned to:

Send me a copy of my responses

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