Student Reimbursement Form for Travel Grant

  • Students may use this form to receive payment of their travel grant awarded for a global health fourth-year elective. This payment is a reimbursement that requires the following:

    1. Completion of a Post-Elective Report. Once the report is completed, notice is automatically sent to Ana Gregory.
    2. Completion of Course 3: Reflection, the third of three courses of the Practitioner’s Guide to Global Health series. You may submit the completion certificate below.
    3. Submission of the form below and electronic copies of your trip receipts.
    Once the above items are submitted, you will receive a check to your mailing address in about three weeks. Questions? Contact Ana Gregory.
  • MM slash DD slash YYYY
  • I. Student & Trip Information

  • This is the person receiving the reimbursement.
  • MM slash DD slash YYYY
  • II. Required Documents

  • Max. file size: 100 MB.
  • Drop files here or
    Max. file size: 100 MB.
    • Note on receipts: Submit your receipts in one PDF or Word document. The total amount of your receipts must be at least equal to the amount of your travel award. Additional receipts above this amount are not necessary to submit. The following receipts are acceptable: flight receipts, program fees, rental fees. Receipts must show proof of payment.
    • If needed, please include any clarifying information regarding your reimbursement above.