GEMS Program Reimbursement Requests
Faculty Last Name
*
Faculty First Name
*
UVA Computing ID
*
School
*
Department
*
Date of Expense
*
Amount of Expense
*
Purpose of this expense (pick 1) - 1. Expenses incurred to meet with a new external mentor, sponsor, or funder away from teh Charlottesville area (your travel expenses or other expenses while away) or 2. Expenses incurred to meet with a new external mentor, sponsor, or funder in the Charlottesville area (their travel expenses or other expenses to host the visitor)
*
Name of Mentor / Sponsor / Funder
*
Title of Mentor / Sponsor / Funder
*
Mentor / Sponsor / Funder's Instl Affiliation
*
Email address of Mentor / Sponsor / Funder
Date of Meeting
*
Location of Meeting
*
What was the purpose of your meeting?
*
How will you build upon this meeting moving forward? What are the next steps for you and the new mentor/sponsor/funder?
*
In submitting this request for reimbursement, I am attesting to the fact that: a) I incurred this expense for the sole purpose of establishing a mentoring relationship with a NEW external mentor, sponsor, or funder (not with someone who is currently part of my mentor network) to support my success as a faculty member at UVA and b) this expense is not reimbursable under a grant or other funds available to me.
*
Please upload your receipts - required for reimbursement
*
Drop your files here
Browse
*
Send me a copy of my responses
Submit
Powered by
Privacy Policy
Report Abuse