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Section A) Payee Information
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Section B) Payee Setup
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Are you currently receiving a Guardian stipend or a student employee of UC San Diego *
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Section C) This form is not needed, please submit using Concur
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Section C) What type of reimbursement are you requesting?
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What type of reimbursement are you requesting *
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Section D) Mileage
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I have provided an estimated mileage from a reliable mapping source. This map will show the total miles traveled and will be used to calculate the round-trip mileage. My personal address has been redacted and only displays my zip code.
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Requested Amount of Mileage Reimbursement
$
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Section E) Parking
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I have provided an itemized receipt that shows the last 4 numbers of my credit card. If the receipt does not show last 4 numbers, I have attached a copy of my credit card statement that shows the charge. All personal information, other than my name, has been redacted.
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Requested Amount of Parking Reimbursement
$
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Section F) Travel - Hotel, Airfare, Meals & Incidentals
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I have provided an itemized hotel folio that clearly displays nightly rates, taxes and other fees
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I have provided receipt/itinerary for my flight that clearly shows my name, type of airfare purchased, total cost and shows last 4 digits of my credit card.
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I have provided itemized receipts for all meals and incidentals. The receipt shows what was ordered, paid for and the last 4 digits of my credit card.
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Requested Amount of Travel Reimbursement
$
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Section G) Events & Business Meetings
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I have provided itemized receipt that shows what was ordered, paid for and the last 4 digits of my credit card.
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I have provided an attendee list and agenda(if applicable)
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Requested Amount of Event/Business Reimbursement
$
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Section H) Supplies
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I have provided itemized receipt that shows what was ordered, paid for and the last 4 digits of my credit card.
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Requested amount of Supplies Reimbursement
$
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Section I) Other
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I have provided itemized receipt that shows what was ordered, paid for and the last 4 digits of my credit card.
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Requested Amount of Other reimbursement
$
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Section K) Reimbursement Information
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Reimbursement Total *
$
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Section J) Receipts and Documentation
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