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Vice President & Chief Student Affairs Officer

Reimbursement to Students and CIOs

Use this form to reimburse a Student. Use this form if you would like the reimbursement to go to your CIO.

Your Name *

Your Email *

Your CIO *

If you do not see your CIO's name in the list, please contact vpsafinance@virginia.edu If you are not a CIO, please select the last option "Not a CIO"

Name of Funding Source you are using for this payment *

SAF

Non-SAF

External Account ID for the Funding Source you are using for this payment *

Funding Confirmation Number for the Funding Source you are using for this payment *

Please list any restrictions for this Funding Source *

General Purpose (Funding may be used for any expenses in your organization)

Restricted Purpose (Funding can only be used for a specific Program/Event)

Please list any restrictions for this Funding Source Restricted Purpose (Funding can only be used for a specific Program/Event)

Total Payment Amount (Total Amount you are paying from your selected funding source) *

Payment Type *

Student to be Paid

CIO to be Paid

Name of Student to be Paid *

Name of CIO to be Paid *

Enter the Student's Student ID number *

CIO to be Paid - Enter the Supplier number of the CIO to be paid. Or if the CIO to be paid has an alumni hall account, but the Alumni Hall Account number *

Email of Student to be paid *

Email of person of contact for the CIO being paid *

Preferred Address for checks to be delivered. This address must match an address in your SIS account. If you have direct deposit, use the address that is linked to your bank account. *

For tax purposes and to avoid payment delays we need to know whether the student payee is a foreign national. This is defined as an individual who is a citizen of any country other than the United States. *

Foreign National

The payee is a US Resident or a CIO

Payment Details

Type and Amount of Payment (click on box, then put in amount. Make sure total equals total payment) *

Travel

Non Travel

Travel Ammount *

Travel - Choose the payment method used. The required documentation for each method is listed below. *

Invoice - Proof of payment: Must show Zero balance

Booking Confirmation - Proof of payment: Must Show non refundable if travel has not happened yet or Zero balance Invoice

Public Transportation - Proof of payment: Receipt if travel has already happened, non refundable if travel has not happened yet.

No receipt - Proof of payment: Screen shot of money deducted from account.

Travel - If this reimbursement includes any of these expenses: Transportation, Lodging, or Meals while traveling, list the expenses followed by the amounts requested. Then, upload documentation. *

For Mileage reimbursements, you will need to upload a completed form. You can download the form here: http://exa-sccm.eservices.virginia.edu/downloads/VPSA/CIO-mileage_form-2019.xlsx

Travel Expense File *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Non Travel Ammount *

Non Travel - Choose the payment method used. The required documentation for each method is listed below. *

Payment App (Venmo, Cash app, Zelle) - Proof of payment: Screen shot of payment, or transaction confirmation

Cash - Proof of payment: Receipt showing amount paid or Written statement acknowledging payment

Credit Card - Proof of payment: receipt or image of amount deducted from bank or on card statement

Check - Proof of payment: Image of check amount deducted from bank account.

List Other Expenses followed by the amount requested. Then upload documentation *

Other Travel Expenses *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Program/Event Details

Name of Program/Event *

Purpose of Program/Event *

Choose the Category that best describes the funded program/event *

Pick which semester the Program/Event will/has happened *

Fall

Spring

Location *

On Grounds (in-person)

Off Grounds (in-person)

Virtual

Choose which best describes this program/event *

New Program/Event

Recurring Program/Event

New Program/Event intended to be recurring

Choose which best describes your planning process *

We started planning the program/event more than three weeks before the event

We started planning the program/event less than three weeks before the event

We started planning the program/event less than three weeks before the event because this was in reaction to some event

What is the date of your event? *

Year

Month

Day

Leave this field blank

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Reimbursement to Students and CIOs

Payment Details

Program/Event Details