Conference Reimbursement Application – LECOM

COM-Erie Conference Reimbursement Application

Application For conference reimbursement for students attending

Name(Required)

First Last

Class year(Required)

School Email(Required)

Pathway(Required)

Student ID number(Required)

Conference name(Required)

Conference Date(Required)

Conference Location(Required)

Please state the amount you are requesting (up to $200).(Required)

Please enter a number from 0 to 200.

In a paragraph, please explain why you are attending the conference.(Required)

In a paragraph, please explain how you will represent LECOM at your conference.(Required)

In a paragraph, please explain how receiving these funds will benefit you.(Required)

Include relevant document screenshots, such as conference registration or Receipts or hotel reservation pages.

Drop files here or

Max. file size: 64 MB.

How would you like to be reimbursed(Required)

Zelle Email

Enter Email Confirm Email

Name

This is to whom the SGA Treasurer will make the reimbursement check out to.

First Middle Last

Reimbursement Address

Where reimbursement check will be mailed if approved

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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