Student Governing Board Reimbursement Form

Einstein Student Council Club Reimbursement Form

Certain expenses are not approved for reimbursement. These include alcohol, speaker fees, and items for personal use (uniforms, T-shirts, and other items that are not publicly available to all students). Further details on acceptable purchases are available. In order to be eligible for reimbursement, all events must be posted to the social calendar and open to all Einstein students. Reimbursements must be submitted within 30 days of the event. You must attach itemized receipts with a location name for all expenses. No exceptions.
Name of Student or Vendor to be Reimbursed *
Do You Have a ClinCard? *

Yes No
Last 4 Digits of Your ClinCard Number *
You'll need a ClinCard in order to submit reimbursements!
If you do not have an OSA issued Clincard, please visit the ClinCard Request Page. At least two days after requesting your ClinCard, please stop by the Office of Student Activities (Belfer 115) to pick up your card (you will NOT receive an email notifying you that it is ready). After you have a ClinCard, feel free to file for reimbursements!

NOTE: Reimbursements may take up to 2-3 weeks to be processed.

If you have any questions, please email einsteinsgb@gmail.com.
Einstein email address of Student *
Phone number of Student *
Name of Organization *
Date of Event *

Month Day Year
Name/Title of Event *
Reason For Reimbursement *
Total Amount for Reimbursement *
Itemized Expenses *
Please upload a copy of your receipt(s).
Should be Empty:

Einstein Student Council Club Reimbursement Form