ࡱ> Q bjbj .Lveivei0 0 lBlO, (+++++++$[/2~++ ,j++V%@t& U & +,0O, &T2^2t&t&2r'H+++|O,20 X : CAREER & CIVIC ENGAGEMENT CENTER TRANSPORTATION EXPENSE REIMBURSEMENT REPORT FOR PROTESTS, RALLIES, & COMMUNITY ORGANIZING EVENTS Name of Student: ________________________________________ Campus Mail Box #: _____ ճԹ ID #: __________ Telephone Number: ______________ E-Mail: __________________ Civic Engagement offers the following funding support for undergraduate students participating in protests, rallied, & community organizing events off campus: 100% transportation reimbursement for students using SEPTA to travel to activism events that occur within the greater Philadelphia region Student Activism Grants of up to $20 per individual to support travel to activism events outside of the greater Philadelphia region. In order to request and receive reimbursement for activism-related travel from Civic Engagement, students must have a completed travel waiver form (available on our website) on file.This form is to be completed and turned in to Civic Engagement IN ADVANCE of the event.Civic Engagement will not process reimbursement requests for students who have not submitted a completed waiver form in advance. Receipts are requiredplease attach all receipts to your completed reimbursement request form.See monthly deadlines on the reverse side of this form. For travel on public transportation, itemize each portion of your trip on a separate line, using extra sheets if necessary. Attach all receipts or your Septa KeyCard statement with your activism trips highlighted. DateName of Organization Coordinating EventOrganization Location: Address, City, & StateMethod of Public Transportation (Train, Bus, Trolley, etc.)Cost$$$$$$$$ TOTAL REIMBURSEMENT REQUEST: $________ For travel in personal vehicle or rideshare service, Civic Engagement uses the IRS Standard Mileage Rate of .625 cents per mile to reimburse students traveling by personal vehicle or rideshare. Rideshare trips are eligible for reimbursement for mileage only, not for the full amount charged for a trip. For rideshare trips, include full trip receipts. For trips in personal vehicle, include a map of your route. You must read and sign the reverse side of this form to complete your reimbursement request. CAREER & CIVIC ENGAGEMENT CENTER TRANSPORTATION EXPENSE REIMBURSEMENT REPORT FOR PROTESTS, RALLIES, & COMMUNITY ORGANIZING EVENTS Name of Student: ________________________________________ Check here if you have direct deposit: _____ If you do not have direct deposit, provide: Campus Mail Box #: _________________ OR US Mail Address: __________________________________________________________ I certify the following: I incurred the above expenses as a participant in a protest, rally or community organizing event. The reported travel expenses are substantiated by the attached, original, itemized receipts which indicate method of travel and amount of payment. No portion of the claimed travel expenses has or will be reimbursed from other sources. Expenses adhere to the College's travel policy and guidelines. Exceptions to the policy have been approved for the following reason(s) as described below: Payee's/Traveler's Signature: _________________________________________Date:___________________ DEADLINES FOR FALL 2023 Email form and receipts to HYPERLINK "mailto:srobertso1@brynmawr.edu"srobertso1@brynmawr.edu by: Payment Issued: September 22, 2023 by Noon October 2, 2023 October 27, 2023 by Noon November 7, 2023 November 17, 2023 by Noon December 4, 2023 December 12, 2023 by Noon January 2, 2024 Questions about activism travel reimbursement? See our policies here: HYPERLINK "/career-civic/student-funding-and-resources/transportation-reimbursement"/career-civic/student-funding-and-resources/transportation-reimbursement Still have questions? 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Attach all receipts or your Septa KeyCard statement with      `2 9 0 your activism   ` 2 90    `&2 9"0 trips highlighted.  ` 2 90     ` 2 K00   ---  ` 2 ]00   jb)  `2 p;)bjDate   ` 2 pX)bj @ Calibri- - -  `- @ !r;-  'bj---  `2 p|jbName of    `2 p jbOrganization   ` 2 pjb  `- @ !r|-  ---  `&2 jbCoordinating Event  ` 2 jb  `- @ !t-  'b---  `2 p- bOrganization   ` 2 pzb   `2 p} bLocation:  ` 2 pb  `- @ !r--  ---  `,2 /bAddress, City, & State    ` 2 b  `- @ !/-  'b---  `2 p bMethod of   `2 p@bPublic  `- @ !ir-  ---  ` 2 bTransportation  ` 2 ]b  `- @ !Z-  ---  `)2 b(Train, Bus, Trolley  `2 Vb,   `2 ]betc.)  ` 2 yb  `- @ !-  'b---  `2 pbCost  ` 2 pb  `- @ !r-  '- @ !a(-- @ !a(-- @ !@a)- - @ !ai-- @ !aj- - @ !a-- @ !a- - @ !a-- @ !a- - @ !a-- @ !Ma- - @ !a-- @ !a- - @ !6b(- - @ !6bi- - @ !6b- - @ !6b- - @ !6b- - @ !6b- j)---  ` 2 0)j  'j---  ` 2 qj  '---  ` 2   '---  ` 2   '---  ` 2 $  ` 2   '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !- j)---  ` 2 0)j  'j---  ` 2 qj  '---  ` 2   '---  ` 2   '---  ` 2 $  ` 2   '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !- j)---  ` 2 0)j  'j---  ` 2 qj  '---  ` 2   '---  ` 2   '---  ` 2 $  ` 2   '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !- j)---  ` 2 0)j  'j---  ` 2 qj  '---  ` 2   '---  ` 2   '---  ` 2 $  ` 2   '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !- j)---  ` 2 0)j  'j---  ` 2 qj  '---  ` 2   '---  ` 2   '---  ` 2 $  ` 2   '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !-  j)---  ` 2 0)j   ' j---  ` 2 qj   ' ---  ` 2    ' ---  ` 2    ' ---  ` 2  $  ` 2    '- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !i- - @ !- - @ !- - @ !- - @ !- j )---  ` 2 0) j  ' j---  ` 2 qj   ' ---  ` 2    ' ---  ` 2    ' ---  ` 2  $  ` 2    '- @ ! 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'- @ !(-- @ !@)- - @ !i-- @ !j- - @ !-- @ !- - @ !-- @ !- - @ !-- @ !M- - @ !- - @ !(- - @ !.(-- @ !.(-- @ !@.)- - @ !i- - @ !.i-- @ !.j- - @ !- - @ !.-- @ !.- - @ !- - @ !.-- @ !.- - @ !- - @ !.-- @ !M.- - @ !- - @ !.-- @ !.- ---  ` 2 =00  0  ` 2 =`0  0  ` 2 =0  0  ` 2 =0  0  ` 2 =0  0  ` 2 = 0  0  ` 2 =P0  0  ` 2 =0  0  ` 2 =0  0  ` 2 =0  0  ` 2 =0  0  ` 2 =@0     ` 2 O00  0  ` 2 O`0  0  ` 2 O0  0  ` 2 O0  0  ` 2 O0  0  ` 2 O 0  0  `2 OP0    `2 OZ 0    ` 2 O0    ` 2 O0  +  `2 O0 TOTAL    ` 2 O0    `2 O0 REIMBU    `2 O 0 RS  `2 O 0 EMENT REQUEST     `#2 O0 : $________  ` 2 O0   @Times New Roman- - -   ` 2 a00     ` 2 q00     `52 00 For travel in personal vehic  `2 0 le or ri  `2 0 de  `2   0 share service  ` 2 V0 ,  ` 2 Y0    `J2 \*0 Civic Engagement uses the IRS Standard Mil       `2 n0 ea  `,2 |0 ge Rate of .625 cents   @Times New Roman- - - - - - - - - - - -   `|2 0K0 per mile to reimburse students traveling by personal vehicle or rideshare.   - - -   `#2 0 Rideshare trips   `2 B0 ar  `72 P0 e eligible for reimbursement    - - - - - - - - -   `h2 0>0 for mileage only, not for the full amount charged for a trip.   - - -   `+2 0 For rideshare trips,   `I2 )0 include full trip receipts. For trips in  - - -   `P2 0.0 personal vehicle, include a map of your route. ---  ` 2 Q0     ` 2 00   ---  ` 2 0     `2 s 0 You must    `A2 $0 read and sign the reverse side of th  `2 0 is  ` 2 0    `2 0 form   ` 2 0    `42 0 to complete your reimbursem     `2 p0 en  `2  0 t request.  ` 2 0   "Arial- -    00//..6't$ ՜.+,D՜.+, hp  hճԹ BRYN MAWR COLLEGE6FOR PROTESTS, RALLIES, & COMMUNITY ORGANIZING EVENTS 6FOR PROTESTS, RALLIES, & COMMUNITY ORGANIZING EVENTS Title Headings 8@ _PID_HLINKSAp Vahttps://www.brynmawr.edu/career-civic/student-funding-and-resources/transportation-reimbursement!_mailto:srobertso1@brynmawr.edu  !"#$%&()*+,-.0123456789:;<=>?@ABCDEFGHJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FU Data '1Table/2WordDocument.LSummaryInformation(IТDocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q