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Rochester Section of the American Chemical Society
Reimbursement Request Form

For the convenience of Rochester ACS Section members and affiliates, a Reimbursement Request Form is available as both a PDF File and an MS Word document. Please adhere to the following guidelines when using the form:

• The reimbursement form is to be used only by those who have obtained permission from the proper committee chair or project leader for expenditures.
  
• The category of the expense for which reimbursement is being sought must be listed (for example: Scholastic Education). If the category is not on the form, the money will NOT be reimbursed. Also, clearly state the nature of the expense in the appropriate space.
  
• All reimbursement request forms must be signed by the project leader or committee chair (for example: Henry Gysling, for Scholastic Education). It is not the responsibility of the Treasurer to track down signatures. Forms submitted without the proper signature will not be honored.
  
• Please provide the name and address of the person or institution to whom the reimbursement check should be sent.
  
• Attach all required receipts to the form, clearly indicating which items are being reimbursed.
  
• All reimbursement requests must be submitted by December 31st of the calendar year in which the expense was incurred.
  
• Mail the completed expense form to the Treasurer:

   

  Mark Heitz 
  SUNY Brockport
  Department of Chemistry
  350 New Campus Drive
  Brockport, NY 14420

To access the form, choose your preferred format and print it out on your local printer: 
MS Word (Reimbursement Form.doc)

Adobe PDF File (Reimbursement Form.pdf)