GEMS Program Reimbursement Requests
Faculty Last Name
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Faculty First Name
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UVA Computing ID
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School
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Department
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Date of Expense
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Amount of Expense
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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)
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Select or enter value
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Name of Mentor / Sponsor / Funder
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Title of Mentor / Sponsor / Funder
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Mentor / Sponsor / Funder's Instl Affiliation
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Email address of Mentor / Sponsor / Funder
Date of Meeting
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Location of Meeting
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What was the purpose of your meeting?
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How will you build upon this meeting moving forward? What are the next steps for you and the new mentor/sponsor/funder?
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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.
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Please upload your receipts - required for reimbursement
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