(New) Pay Reimbursement Request- Check

Fiscally Sponsored Project Name*

Fiscally Sponsored Project Email*

Reimbursement paid to*

Reimbursement is paid out to the name that matches receipts.

Check Amount*

How would you like the check delivered?*

Mail to sponsored project: If you’ve recently moved, please notify us of your new address.
Hold for pick-up: An email notice is sent when your check is ready.
Mail to Reimbursement Recipient

Reimbursement Recipient Address*

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

How will you deliver your Receipt(s) and Reimbursement Report to DG?*

Original receipts must indicate how the expense was paid (cash, check, credit card). Dancers’ Group also requires a copy of cancelled checks or credit card statement based on the receipt. If you have more than one receipt- be sure to complete a Reimbursement Report.

Upload to this form (CC statements & electronic purchases only)
Mail to Dancers' Group with Reimbursement Report
Drop off in person with Reimbursement Report

Upload Receipt, Cancelled Check, Credit Card Statement, and/or Reimbursement Report (if you are submitting more than one receipt)*

Recommended: black out all but the last four digits of account numbers and unrelated purchases on bank and/or credit card statements. (Need an example of a Reimbursement Report? There's a link above)

Expense Category*

These expense categories align with DataArts and you will note a few changes.

Expense Category Notes

Additional Comments

Phone

This field is for validation purposes and should be left unchanged.

(New) Pay Reimbursement Request- Check

New as of 5/14/2020:

When submitting multiple receipts for reimbursement a Reimbursement Report is required

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