Indianapolis Medical Student Mileage Reimbursement Request

If Indianapolis is not your "home base" contact your campus travel coordinator to submit your mileage reimbursement.

Mileage may be reimbursed for medical students who are required to travel to locations beyond a fifty (50) mile radius of the student’s official “home base” campus or residence, whichever is less.

Mileage is reimbursed according to Indiana University’ travel policies.

Mileage reimbursement requests must be received within 120 days of the travel start date or sooner. Anything requested after 120 days of the start date will not be reimbursed.

Reimbursement is limited to 1 round trip per rotation regardless of rotation length.

First Name

Last Name

Student Email

Student University ID #

Home Base Campus

You must be an Indianapolis "home base" student to use this form to request mileage reimbursement.

Travel Purpose

What Clerkship rotation are you attending?

Date of Pre-Approval

By entering a date you verify that you are an Indianapolis based student who has received a request to attend a mandatory IUSM- Medical Student Education commitment that is more than 50 miles away from your official "home base" site or residence, whichever is less.

mm/dd/yyyy

Rotation Assignment Documentation

Proof of Clerkship Rotation Assignment must be included for this request to be processed.

Drop your files here

To Address

From Address

Rotation Start Date

mm/dd/yyyy

Rotation End Date

mm/dd/yyyy

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