2026 Expense Reimbursement Application

Applicant Information

Name

Make check payable to (individual or institution)

This address will receive a confirmation email

Phone

Address where the check should be sent

Today's Date

Individual filing the application (if different from the recipient)

Name

Phone

This address will receive a confirmation email

Your role at the church

Expense Information

Description of Expense #1

Date of Expense #1

Amount of Expense #1

Attach receipt for Expense #1

Upload (8MB)

Description of Expense #2

Date of Expense #2

Amount of Expense #2

Attach receipt for Expense #2

Upload (8MB)

Description of Expense #3

Date of Expense #3

Amount of Expense #3

Attach receipt for Expense #3

Upload (8MB)

Attach additional documentation, if needed

Upload (8MB)

Mileage Reimbursement

2026 rates - 72.5¢ per mile for travel on or before June 30. 76¢ per mile for travel on or after July 1.

Date(s) of Trip #1

Starting Address

Ending Address

Type of Trip Round Trip One Way

Number of Miles on Trip #1

Reimbursement Amount for Trip #1 (miles x $.725 OR $.76 depending on the trip date)

Reason for Trip #1

Date of Trip #2

Starting Address

Ending Address

Type of Trip Round Trip One Way

Number of Miles on Trip #2

Reimbursement Amount for Trip #1 (miles x $.725 OR $.76 depending on the trip date)

Reason for Trip #2

Total Amount for Reimbursement

Add together the amounts from each section and report the total here.

Description

Please fill out this form and click submit.

2026 Expense Reimbursement Application

Description

Please Fix the Following