CE Surplus Usage Fund Form

To utilize these educational surplus funds please complete the below request form outlining how much is being requested and for what use. Once this is reviewed and approved you will be notified and will then be required to submit actual expense receipts for reimbursement, or invoices from vendors related to educational events. 

(For example, you can submit a receipt from a vendor showing you paid $400 for catering for an educational conference and we will be able to reimburse actual expenses. This receipt must be accompanied by a full agenda for the event and a list of attendees. Or, you can send us the catering invoice directly with the agenda and list of attendees and we can pay the vendor on your behalf.  One other key point, UMMC cannot reimburse taxes, so if the organization using the surplus funds is not tax exempt it may be best to let us pay the vendor directly to avoid taxes.) 

* = Required Fields

UMMC Department:*	*
Designated business contact
First Name*	*
Last Name*	*
E-mail Address:*	*Invalid Email
Phone Number:*	() - ******
Amount of funds requested for use.*	*
Brief explanation of use of funds and how it relates to educational mission.*	*
Signature*	*
Date*	*Invalid Date