Student Reimbursement Request Form : Ingram School of Engineering : Texas State University

This form is for reimbursements for personally purchased items/fees by engineering majors with the Ingram School of Engineering.

Note:

Items must be received before submitting the reimbursement.
If you plan to submit a receipt for office supplies, chemicals, software, or any other items that a BobCatalog Vendor could supply, your request will be denied, and you will NOT be reimbursed.
If this is a purchase related to an engineering course, this reimbursement will go through Financial Aid.
If you owe money to the University, you will NOT be reimbursed; instead, the amount will be applied toward your outstanding balance on your student account.

Name of Person Completing this form: *

TxSt Email Address: *

Are You Employed By TXST: *

Yes

If you are not employed by Texas State, please input your mailing address (Apt#, Street, City/Town, State - Zip Code):

Program/Unit:

This is typically your affiliation, unless you are ordering on the behalf of another.

MFGE

MS Eng

Engineering Support Services

Office

Category of Order

Category: *

If selected "Office Expense" or "Lab Supplies" please enter Room#:

Sub Category: *

Reason for Reimbursement

Be specific! If the purchase was made for research/project/class, etc., make sure to include the type of research, the title of the class, or any other pertinent details.

Failure to do so will result in delayed processing times of your reimbursement.

Reasoning: *

If selected "Class Support" please complete the following section:

Prefix:

Course: (ex. 1304)

Section:

Research Related: *

Receipt Information

Item(s) purchased from (ex. Amazon, etc): *

Date of Purchase: *

Date Item(s) Received: *

Amount of Purchase: *

Is this a reimbursement for food:

Yes

If so, please list the attendees (please make note of non-TX State attendees)

Funding Information

If using a specific grant/personal account for reimbursement, please specify. Enter the Source of Funds, and complete the Cost Center/Fund/Account information in the fields below.

Source of Funds: *

Required: Cost Center / Fund / Account Number:

Please provide account number to expedite the purchase.

Upload your receipt and bank/card statement below as a PDF

You will not be reimbursed for sales tax.
To help with processing, you must attach a snapshot of the charge from your bank/card statement.
Required information includes your name, relevant charge, and the last four digits of the relevant card, if available. Please black out all other info.

Receipt: *

Bank/Card Statement *

Certification Statement

By checking this box, I acknowledge that this serves as my signature and validation of the expenses listed on the reimbursement request with the corresponding receipts attached. I certify that the expenses are correct, were paid with my personal funds, and have not been paid or reimbursed previously by the university or by any other means. *

I certify that the above statement is true.

If you happen to see this, do not fill this field.