PROFESSIONAL DEVELOPMENT REIMBURSEMENT FORM

Scholars must submit this Professional Development Reimbursement form within 30 days following the presentation. The scholar must have previously submitted the Advanced Pre-Application Form, 30 days before the presentation.

Scholar Name:
Institution:
Name of Event
Event City and State
Date of Event:
Phone:
Mail Check to Address:
Actual Out of Pocket Expenses: Line item/detailed receipts are required.	Amount
Registration Fee:	$
Lodging:	$
Meals:	$
Travel Airfare:	$
*Travel Mileage	$
Round Trip From: To:	$
Other Expenses:	$
Explain:
*Travel by privately owned automobile will be calculated at .51cents/mile, not to exceed the round-trip coach airfare cost.
Total	$

I verify that the information provided above is correct.

Office Use Only: SREB ID Amount to Reimburse: Approved by: Date: [ Scholar Signature Date Email form and receipts to Monique Waddell on Monique.waddell@sreb.org or

Mail to 592 Tenth Street, NW, Atlanta, GA 30318-5790 Attn: Monique Waddell