Center for Diversity in Engineering/ UVA Clark Scholars ProgramStudent/CIO Reimbursement Requests

Center for Diversity in Engineering/

UVA Clark Scholars Program

Student/CIO Reimbursement Requests

Please use the below form to complete an official reimbursement request. This form is to be used by students requesting reimbursement from their respective CIO gift accounts and/or the Center for Diversity in Engineering/Clark Scholars Program. Please note, if you do not have a current Workday record, the reimbursment coordinator will need to intiate a request for you to register in Payment Works to receive reimbursements.

Reimbursements for travel expenses must be submitted upon completion of travel, not before, and within 30 days of the date of return. For all non-travel transactions, expenses must be submitted within 30 days of incurring the expense. Please see policy FIN-004: Travel, Meals and Entertainment Expenses Incurred on Behalf of the University

Student Name*

Last Name, First Name, MI (as it appears in SIS)

UVA email address:*

(e.g. mbu6z@virginia.edu)

Do you currently hold a position within Workday?*

Please note whether you have an active workday profile.

Select

Type of Reimbursement Requested:*

PLEASE USE THE SECOND OPTION FOR ANY MEAL REIMBURSEMENT REQUEST (ADD'L INFORMAITON IS REQ'D)

Travel (airfare, lodging, mileage, ground transportation, travel misc.)

Travel and Non-Travel Meals (includes local business meals - C'Ville >1 person)

Other (supplies, etc.)

Req'd additonal information for Business Meals*

Please include number of people dining, names if under 10 ppl.

Please Describe "Other"*

For mileage reimbursements please provide starting address:

*leave blank if you are not requesting mileage*

For mileage reimbursement, please enter ending address:*

For Mileage, round trip?

Select

Total Reimbursement Amount Requested:*

Student Group/Activity*

Select

If other student group/activity please describe:*

Please provide a justification statement regarding your reimbursement request:*

Charge account:*

Please indicate whether you are requesting reimbursement from your respective CIO gift account i.e. NSBE, SHPE, SWE, SASE, oSTEM, Clark Scholars Program (Stipend/Pillar), Office of Diversity, Equity and Engagement or Center for Diversity in Engineering)

File Upload*

ALL SUBMITTED EXPENSES FOR REIMBURSMENT MUST BE ACCOMPANIED BY ORIGINIAL ITEMIZED RECEIPTS, REGARDLESS OF AMOUNTS. Please submit only OFFICIAL (order confirmations, etc.) receipts related to this request; credit card statement screenshots will not be accepted.

When providing screenshots, please avoid cropping out important info such as:

• Vendor/seller name

• Date of purchase

• Method of payment (e.g. VISA ending in XXXX)

• Purchases included – ALL line items.

• Amount Paid

If a replacement receipt cannot be obtained, please complete the Missing Receipt Afadavit and attach to the file upload.

REIMBURSEMENT FOR TRAVEL EXPENSES WILL NOT BE PROCESSED UNTIL AFTER THE COMPLETION OF TRAVEL.

For meal reimbursements you must include itemized and credit card authorization receipts. If the meal was for multiple people, please include the names of individuals in the Req'd informaiton for Business Meals" section

**Catering and gas (only mileage) cannot be reimbursed per UVA Policy. **

ALCOHOL WILL ONLY BE REIMBURSED IF YOU HAVE PRIOR AUTHORIZATION FOR PURCHASE

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