Microsoft Word - Expense Reimbursement Form.doc
Chicago Academy of Nutrition and Dietetics
Request for Payment / Expense Reimbursement Form Attachment
Committee: ________________________________________________________________
Name: ______________________________________________________________________
Address: ________________________________________________________________
Phone: ________________________e-mail: ________________________________________
Reason for Expense: Eg(CAND Scholarship, PPW workshop, Meeting Food Expense, Stationary)
_________________________________________________________________________________________
_________________________________________________________________________________________
Please use this form as an attachment to Expense Request Form. Be sure to list expenses below along with either the reason or budget category for the expense for tracking purposes. Remember to attach all receipts to this form.
Expenses for Reimbursement:
Date: Reason/Budget Category: Expense:
$
$
$
$
$
$
$
$
Total Reimbursement: $ _
Approved by:__________________________________________
Approval Date:_________________________________________
CAND Position: _________________________________________
Submit to CAND Treasurer:
Amanda Seguin
aseguin73@
Last updated: 11/26/2014
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