Hematology Faculty Expense Reimbursement Form

Please use this form for expense reimbursement for memberships, publication costs, conference registrations, travel, renewals, and other expenses

Requesting Faculty Name

Please enter Last Name, First Name

Email address

Please enter your email address

Please choose Admin

Select

Total Reimbursement Amount

Please enter the total amount of reimbursement

Reimburse from which PTA/Fund source?

Where do you want this reimbursed from? Which fund? For STAP, please fill the form and attach it to the files below https://stanford.box.com/s/g9obsduwjeiv71fm8p2xw25s2pvebok9

WHO - Attendees

Please provide the names of the attendees.

WHAT - Event description

Please provide a description of the expenditure, event, meeting, conference, etc.

WHEN - Start Date

WHEN - End Date

WHERE - Location

Please enter the city and place where the event was held/the name of the organization etc.

Why - Description/Justification

Please enter why this expenditure is justifiable for the project/PTA

Conference related expenses?

Yes

Conference Registration

Please enter the amount

Conference Institution

Please enter the name of the Vendor for gift purchases or reimbursement of materials purchased

Airfare

Enter amount

Airline

Hotel Expenses

Enter Amount

Name and Hotel Address

Ground Transportation

Enter amount for Uber, Lyft, Taxi

Parking

Enter Amount

Meals Date

Breakfast

Please enter amount for breakfast

Lunch

Enter Amount for Lunch

Snacks

Please enter amount for snacks

Dinner

Please enter amount for Dinner

Other Expenses

Details of Other Expenses

File Upload

Drag and drop files here or

Send me a copy of my responses

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