Geosciences Non-Employee Reimbursement Request

Please complete this form and upload original, itemized, proof paid receipts along with the substitute W-9 form.

Payee Information

Payee Name (Last, First)*

Home Mailing Address*

Please provide a home mailing address. The UA Financial Services office will not submit payment to a business address.

City, State, Zip Code*

Payee Email Address*

Payee Phone #*

Phone

U.S. Citizen*

Yes

Foreign Visa Information (Type, Country)

If you are not a U.S. Citizen, please include your visa type and country of origin. A member of the Geosciences business office will reach out to gather further information.

Detailed Reimbursement Information*

Please detail your reasoning for seeking reimbursement from the Department of Geosciences at The University of Arizona. Please include any applicable information such as travel dates, work with certain University labs/PI's, etc.

University of Arizona Employee Contact*

Please include the name of the UA employee who is most familiar with this reimbursement request.

Expense Detail

Please list the dollar amount for each applicable expense.

Airfare Cost

Lodging Cost

Private Vehicle Mileage (65.5 cents/mile)

If claiming vehicle mileage, please include either beginning and ending odometer readings or attach a R/T google map of the route.

Beginning Odometer Reading

Ending Odometer Reading

Rental Vehicle

Fuel

Please note that fuel cannot be reimbursed if you are claiming private vehicle mileage.

Public Transport (train, Uber/Lyft, taxi, etc.)

Meals

Other/Miscellaneous

File Upload*

Please upload a scan of all itemized/proof paid receipts along with a completed substitute W-9 form. Please note that PDF is the preferred file method, however, JPEG is also accepted.

https://www.geo.arizona.edu/sites/www.geo.arizona.edu/files/w-9_substitute.pdf

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