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, or the event date, whichever is sooner.

View the Reimbursement Information & Guidelines

Section A) Payee Information

Payees must be a Principal Member of the student organization.
Payee Name Payee Name First Last
Email
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.
STOP HERE

You cannot proceed with this form because you are not listed as a Principal Member of the Student Organization. Please have an actively registered Principal Member complete and submit the form. Thank you!
Section B) Payee Setup

Please complete the following questions to assess your payee registration status.
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
Have you registered in PaymentWorks?

Have you registered in PaymentWorks? Yes, I have registered in PaymentWorks No, I have not registered in PaymentWorks
Please provide the email address used to set up your PaymentWorks account, OR your PaymentWorks assigned vendor number.
Concur Delegate

Before proceeding with the form, please complete the following:

Please add your Fund Manager as a delegate in Concur following these steps.

You can find your Fund Manager here.

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

Before proceeding with the form, please complete the following:

Please email your Fund Manager to request a PaymentWorks Account Invitation. (You do not need to wait for a response to submit the form.)

You can find your Fund Manager here.
Payee has already been set up in Concur; no further action is required.
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 (eMarket) 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
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.

View the examples of acceptable vs. unacceptable receipts
Receipt Verification

Please answer *Yes* or No to the following statements about your 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 such as card type with last four digits (e.g., Visa 1234), or cash.	My receipt(s) show how the items were purchased - Form of payment such as card type with last four digits (e.g., Visa 1234), or cash.Yes	My receipt(s) show how the items were purchased - Form of payment such as card type with last four digits (e.g., Visa 1234), or cash.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

Associated Students (A.S.) Operating Funds

For printed materials, please also upload a copy or image of the design that clearly displays the student organization’s logo.
Additional Documentation Required for Payment Verification

For all receipts without the last four digits of the card number (e.g., Visa **** 1234), cash payment confirmation, OR balance due is not $0.00, please also upload a screenshot or image of the posted expense(s) as it appears in your bank account statement for verification purposes.
Upload PDFs of receipts

Attach Files
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.
Note

If you do not receive a response from the Student Life Business Office (SLBO) within 10 days of your submission date, please follow up by forwarding your submission confirmation email to slboreimbursements@ucsd.edu to check on the status of your request.
Spam Protection. Please answer this simple question:
What is the sum of 3 and 4 ?

Non-Event Reimbursement Form

Non-Event Reimbursement Form

Section A) Payee Information

STOP HERE

Section B) Payee Setup

Concur Delegate

PaymentWorks Account Setup

Payee has already been set up in Concur; no further action is required.

Section C) Funding Information

Section C) Expense Information

Section D) Totals

Section D) Receipts and Documentation

Receipt Verification

Associated Students (A.S.) Operating Funds

Additional Documentation Required for Payment Verification

Additional Notes

Note