GEMS Program Reimbursement Requests

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)*

Select or enter value

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*

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