Reimbursement Request

Please fill out this form and click submit.
Personal Information

 
 
If you are not on staff at Heartland Youth For Christ, please let us know your address. We will send a check to your preferred location.
 
 
Expense Description

 
 
 
 
Expense Allocation

Please select all that apply.
 
 
 
Document Upload

Please upload all receipts. You may take a picture of all receipts and upload them in fewer files if needed.
Lost receipt

If you do not have access to your receipts, please read and sign your name below. Expenses without receipt are not guaranteed reimbursement, and you may be asked to retrieve the receipt before reimbursement will be provided.
I hereby that I paid for the expenses listed above and:
       1. No receipt was given or the receipt was lost.
       2. There expenses were incurred in the conduct of official 
           business.
       3. I have made no previous claims for these expenses
 
By typing your name above, you are signing and agreeing to the terms outlined in the Lost Receipt section.

Description

Please fill out this form and click submit.