Non-Event Reimbursement Form

Use this form to submit a reimbursement request for non-event expenses, such as Operating Funds expenses and other supplies.

ALL requests must be submitted within 14 days of the purchase date listed on the receipt(s).

Section A) Payee Information

Payees must be a Principal Member of the student organization.
Payee Name Payee Name First Last
PID
Student Organization
I am a Principal Member of the Student Organization listed above.

I am a Principal Member of the Student Organization listed above. Yes No

Must be a Principal Member of the student organization in order to receive reimbursement.

View the Center for Student Involvement's list of Registered Student Organizations and their Principal Members.
Email
Phone Phone - ### - ### ####
Section B) Payee Setup

To receive reimbursement, all payees must either:
• Register in Payment Works [If you are not a student worker or UC Employee, you will need to register through PaymentWorks. If you have not already registered, please reach out to your Fund Manager to receive a registration link.]
• Add their Fund Manager as a Delegate in Concur [if you are a current UCSD Student Worker/Employee]
Are you a current student worker or employee of UC San Diego?

Are you a current student worker or employee of UC San Diego? No, I am not a current student worker or employee of UCSD Yes, I am a current student worker or employee of UCSD
Have you added your SLBO Fund Manager as a Delegate in Concur?

Have you added your SLBO Fund Manager as a Delegate in Concur? Yes, I have added my SLBO Fund Manager as a Delegate in Concur No, I have not added my SLBO Fund Manager as a Delegate in Concur

If you answered "No" to this question, your reimbursement may take longer to process.

To ensure timely processing, please add your SLBO Fund Manager as a Request Delegate and Expense Delegate in Concur at this time, as SLBO cannot proceed with your request until this step is completed.

In Concur, choose the following permissions:
- Can Prepare
- Can Submit Reports
- Can Submit Requests
- Can View Receipts
- Receives Emails

See KBA and Video for instructions on how to add delegates in Concur.

Find your SLBO Fund Manager on our website. Contact your Fund Manager for any questions.
Have you registered in PaymentWorks?

Have you registered in PaymentWorks? Yes, I have registered in PaymentWorks No, I have not registered in PaymentWorks

If you answered "No" to this question, your reimbursement may take longer to process.

To ensure timely processing, please register in Payment Compass at this time, as SLBO cannot proceed with your request until this step is completed.
Section C) Funding Information
What is your Funding Source? [At least one must be selected]

What is your Funding Source? [At least one must be selected] Associated Students (A.S.) Operating Funds Student Life Business Office (SLBO) On-Campus or Gift Account Parent Funds Other: List details below (Department Funds, etc.)
Section C) Expense Information
General Purpose of the Purchase/Description of Items:

Example: We purchased flyers and 1 banner for student organization promotion, to be covered by our org's remaining operating funds balance
Do the items purchased align with the guidelines of your approved funding source(s)?

Do the items purchased align with the guidelines of your approved funding source(s)? No, my purchases do not align with the guidelines of the funding source(s) Yes, my purchases align with the guidelines of the funding source(s)

For any answer to this question, your reimbursement is subject to further review.

To ensure that your items are reimbursable, check the guidelines of your funding source.

For any questions, contact your SLBO Fund Manager.
Section D) Totals
Reimbursement Total $ Dollars . Cents
Note: For purchases whereby tax was not paid, USE tax may be deducted from the reimbursement total
Maximum Funding

Maximum Funding I understand that my reimbursement total will not exceed the amount of awarded funding.
Section D) Receipts and Documentation

To be considered valid for reimbursement, receipts must align with the receipt requirements.
Upload PDFs of receipts

Attach Files
Receipt Verification

Please answer *Yes* or No to the following statements about your provided receipt(s):

If you answered No to any of the statements, additional documentation may be required.
	Yes	No
My receipt(s) show where the items were purchased - Store/restaurant location	My receipt(s) show where the items were purchased - Store/restaurant locationYes	My receipt(s) show where the items were purchased - Store/restaurant locationNo
My receipt(s) show when the items were purchased - Date/time	My receipt(s) show when the items were purchased - Date/timeYes	My receipt(s) show when the items were purchased - Date/timeNo
My receipt(s) show what items were purchased - Itemized list	My receipt(s) show what items were purchased - Itemized listYes	My receipt(s) show what items were purchased - Itemized listNo
My receipt(s) show how the items were purchased - Form of payment (card type and truncated card number; cash; etc...)	My receipt(s) show how the items were purchased - Form of payment (card type and truncated card number; cash; etc...)Yes	My receipt(s) show how the items were purchased - Form of payment (card type and truncated card number; cash; etc...)No
My receipt(s) show the total $ amount of the items purchased and a $0.00 balance due	My receipt(s) show the total $ amount of the items purchased and a $0.00 balance dueYes	My receipt(s) show the total $ amount of the items purchased and a $0.00 balance dueNo

Additional Notes
If there is any other information about your reimbursement that you would like to provide to your SLBO Fund Manager, add them below.

Non-Event Reimbursement Form

Non-Event Reimbursement Form

Section A) Payee Information

Section B) Payee Setup

Section C) Funding Information

Section C) Expense Information

Section D) Totals

Section D) Receipts and Documentation

Receipt Verification

Additional Notes