PRS FIT Scholarship Reimbursement Request

PRS FIT Scholarship Reimbursement Request

Please complete the fields below to submit your request for reimbursement as per the terms of the FIT Scholarship. Recipients may request one reimbursement for up to $1000 during the course of their fellowship. Requests must be submitted within one month of the event attended.

Date of Request*

Full Name*

Mailing Address 1 for Reimbursement Check:*

Street Address

Mailing Address 2 for Reimbursement:*

City, State, Zip

FIT Email*

Fellowship Program*

Fellowship Program Director*

ACR Event Attended*

ACR Convergence

Winter Rheumatology Symposium

Musculoskeletal Ultrasound Course for Rheumatologists

ACR Education Exchange (Formerly SOTA)

Pediatric Rheumatology Symposium (PRYSM)

Event Dates*

Event Location*

Total reimbursement requested*

PRS will reimburse up to $1000 for registration, travel, hotel and meals. You will be asked to upload receipts below.

Itemized expenses*

Please list each expense with name on receipt, amount, and type

Example: Hyatt Regency Hotel: "$425.66 - Hotel"

Driving and mileage

If you drove to the event, your mileage may be submitted part of the reimbursement. Pease indicate your exact starting point destination, and total roundtrip miles. Mileage will be reimbursed at the current US government reimbursement rate.

File Upload*

Upload ALL receipts / documentation to support your reimbursement request.

Drag and drop files here or

Send me a copy of my responses

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