Faculty Reimbursement Request

Request reimbursement for any expenses to be charged to Infectious Disease accounts

Date*
MM slash DD slash YYYY
Name*
First Last
Email*
Phone Number*
Address*

Address for check to be mailed to (confirmation to reduce mailing errors)
Reimbursement Type*
1. CME Stipend/Faculty Allowance – Annual stipend allocated to faculty for CME/Professional Development. AY25 is budgeted at $2,000 per faculty per year and $1,000 for APPs per year. These funds cannot be rolled over to future years. 2. MD/APP Required Expense – The Section will reimburse physicians and APPs for the following expenses: Massachusetts Controlled Substance Registration, Drug Enforcement Administration (DEA) License Renewal, Board of Registration License Renewal, & Credentialing fees. 3. Other– Reimbursement on an account other than what's listed above. For example, a Recruitment/Development account (a financial agreement between DOM and a faculty member to support their program development/research program).
Account (nickname or project number)*

Note that BMC project/grant number starts with a number 4, BU Internal Number starts with a 9
Is Grant Manager aware of expense?*
Description of Expense*
What is the expense? If research related - how does the expense benefit the project?
Total Requested Reimbursement Amount (USD $)*
Upload receipts and other confirmatory information*
Drop files here or

Max. file size: 100 MB.
All expenses require detailed receipts. If last 4 digits of card used are not visible on receipt, a bank or credit card statement (pending charges are allowed) is required.