Submit Reimbursement - Northeast Regional Children's Advocacy Center

Click here to download NRCAC Reimbursement Instructions

NRCAC Training Expense Reimbursement

If you are completing this reimbursement form on behalf of another person, please check this box and complete the additional fields.

Requestor Information

First Name

Please only write one name in this field. If you are completing this form for multiple people, please add their names in the "notes" section by clicking "Yes" next to "Do you have any other expenses that are not listed above?"

Last Name

Please only enter one name in this field.

Email Address

Request Information

First Name

Last Name

*Please use the attendee's (not requester's) email address.

Title

Organization/Agency

Event Name

Event Date

Start Date of Event

Event Location

If other, please name the event here.

Expense Breakdown

Receipts are required for all reimbursement items other than meal per diems and mileage. Without receipts you will not be reimbursed. Copies of boarding passes are required for all air and train travel. Reimbursement forms and receipts must be submitted no later than thirty days after the event for which reimbursement is being requested.

Enter numbers without dollar signs for all fields.

Registration

Copy of paid registration confirmation & certificate of attendance/completion required

Air/Train Fare

Coach class; receipt & copy of boarding pass required

Baggage Fees

Receipts required

Parking

Receipts required; tips/gratuities are not able to be reimbursed

Taxi, Uber/Lyft or Shuttle

Receipts required; tips/gratuities are not able to be reimbursed

Tolls

Receipt or EZPass statement required

Personal Mileage

Enter total # of miles for round trip travel - map required!!

Personal Mileage Amount

Auto-calculated: total miles x $0.67/mile

Lodging

Only government per diem rates can be reimbursed; receipt showing the room rate before taxes/fees is required.

If your hotel is over the federal per diem rate, no part of the hotel cost may be reimbursed. Please contact NRCAC or check www.gsa.gov/perdiem for current rates.

Do you have any other expenses that are not listed above?

Yes

Other Expenses (total cost of other expenses WITHOUT dollar sign)

Explanation of expense required below.

Notes (cost breakdown for other expenses)

Please use Notes section below to describe the above listed expense.

Total Reimbursement

Check Details

Check should be made out to

Street Address

City

State

ZIP Code

Our parent organization, Philadelphia Children's Alliance, utilizes Bill.com to pay all reimbursements. During the reimbursement process, you will be sent an invitation to create a secure payment profile with Bill.com, where you will be able to select on Bill.com whether you would like to be sent a paper check to the above address or receive an ACH payment direct deposited into your account. If you have already received reimbursements from NRCAC/PCA through Bill.com, you should use the same Bill.com account.

Please enter the email address that should receive the invitation for your Bill.com profile, or is associated with your existing profile:

Receipts

Please use this area to attach your documents (receipts, boarding passes, mileage maps, etc.)

One combined PDF attachment is preferred!

NOTE

If you are submitting two separate forms for reimbursement to yourself and your organization/agency, please only include the back up documentation that pertains to the record you are submitting.

File types accepted are: PDF, JPG, PNG

NRCAC is supported with funds awarded through OJJDP Grant Award Number 15PJDP-22-GK-03061-JJVO.

Boarding passes & receipt for coach class ticket purchase are attached to this request.

Yes	I am not requesting air or train fare

Contact Information