Reimbursement form

- Funding -

Submit this form to request reimbursement for chapter expenses that comply with NAAMA NextGen funding rules. Only chapter board members can submit reimbursement requests, and all requests must be filed within 30 days of the expenditure with receipts attached.

I am(Required)

Chapter Academic Institution(Required)

Select the Academic institution your chapter is established at. If it is not shown please email national@naamanextgen.org

Title of Event(Required)

Type of Event(Required)

Date(Required)

Please enter the date of the event

Event Information Description(Required)

Please enter a brief description of the event. This will be used for for funding approval and chapter spotlights in the member newsletter and national Instagram.

Include What the event is, Where the event was located.
Optionally add Why this event was helpful/what attendees took away from it and a brief quote from an attendee.

Flyer(Required)

Accepted file types: pdf, png, jpg, jpeg, Max. file size: 512 MB.

Please upload Event description and flyer as outlined in the rules.

Photos(Required)

Drop files here or

Accepted file types: pdf, jpeg, png, jpg, Max. file size: 512 MB, Max. files: 10.

Please Upload up to 10 Photos of Event

Number of Attendees(Required)

Enter the estimated number of attendees

Email(Required)

Enter Email Confirm Email

Enter your Email. This will be used to send a conformation. Please use the same email as your NAAMA NextGen account

Name(Required)

First Last

Please Enter your full name as on record with NAAMA NextGen.

Claimant Information

Please Enter the following information of the member who is to receive the check reimbursement. Please double check all fields for typos as incorrect information delays the check.

Legal Name of Claimant(Required)

First Last

Please type the exact legal name the check is to be addressed to. Please double check for typos or check may be delayed.

Email of Claimant(Required)

Enter Email Confirm Email

Please enter the email of the claimant. (The student who needs a reimbursement)

Phone Number of Claimant(Required)

Please double check phone number is correct

Mailing Address of Claimant(Required)

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

Please enter the exact address the check is to be mailed to.

Exact Reimbursement Amount(Required)

Please enter a number greater than or equal to 0.

Enter dollar amount of reimbursement requested

Receipts(Required)

Accepted file types: pdf, Max. file size: 512 MB.

Please Attach Receipts as a single PDF as outlined in the rules for reimbursement.

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