HSC Academic Workstation Reimbursement Program Application

Name of person completing application:*

Contact Email Address*

Phone number for person completing application:*

Department Name (If your department is not on the list please email hsc-cio-notices@salud.unm.edu):*

Select

Is your COMPLETED Request for Disposal (RDA) form attached?*

Is your Paid Invoice attached?*

Number of reimbursements requested?*

Select

Index to be reimbursed (xxxxxx) CANNOT BE A GRANT:*

REQUIRED Attachments: BOTH RDA AND Paid Invoice*

These attachments are required to be considered for the reimbursement.

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