Mazama Reimbursement Form

Before you get started, let's make sure you have everything you need to complete this form.

Do you have your receipt(s)? (required)

Was your expense pre-approved by your committee chair/department head?
(if not, email them before completing this form)

Please note: We reimburse via paper checks. Checks will usually be sent within 2–4 weeks. Please deposit your reimbursement check promptly upon receipt.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

What type of expense is this? *

Committee

Staff

Other

Are you the committee chair? *

Yes

No

Select your committee name from the list. This will route a copy of this email to your committee chair for approval. *

Select the person/department who should approve this expense. *

Receipt 1

The category is a description of the expense. In your budget, all expenses are coded to specific categories. Please review the budget and assign the appropriate code based on that budget.

Select the appropriate class below. The class is likely the name of your committee. (Class is a Quickbooks term)

Department (CLASS) *

Category *

Is this for mileage? *

Yes

No

Start/End Location for Mileage (i.e. MMC to Smith Rock State Park and back) *

Purpose (i.e. ICS Field Session) *

Enter # of miles driven (.14 per mile) *

Mileage Total

0.00

Amount *

Date * +

Vendor Name (e.g. Red Cross, Safeway) *

Receipt 2

Department (CLASS)

Category

Is this for mileage?

Yes

No

Start/End Location for Mileage (i.e. MMC to Smith Rock State Park and back)

Purpose (i.e. ICS Field Session)

Enter # of miles driven (.14 per mile)

Mileage Total

0.00

Amount

Date +

Vendor Name (e.g. Red Cross, Safeway)

Receipt 3

Department (CLASS)

Category

Is this for mileage?

Yes

No

Start/End Location for Mileage (i.e. MMC to Smith Rock State Park and back)

Purpose (i.e. ICS Field Session)

Enter # of miles driven (.14 per mile)

Mileage Total

0.00

Amount

Date +

Vendor Name (e.g. Red Cross, Safeway)

Receipt 4

Amount

Date +

Vendor Name (e.g. Red Cross, Safeway)

Category

Department (CLASS)

Additional Detail about expenses

Receipt 5

Amount

Date +

Vendor Name (e.g. Red Cross, Safeway)

Category

Department (CLASS)

Additional Detail about expenses

REQUIRED for everything but mileage requests.

Upload your receipts (please circle the relevant items on the receipt before uploading). You may be required to mail original receipts to the office, so please do not discard the originals.

Remember—it'll take 2–4 weeks for an expense to be reimbursed. Your request will be routed to the committee chair and then it will be sent on to the finance team if it is approved. If it is not approved (i.e. it wasn't a budgeted expense), you can expect to hear from your committee chair.