Training and Risk Management Reimbursement Request Form

Reimbursement Request Form

Each participating ERMA member agency is eligible for reimbursement of up to a total of $2,500 per Program Year (7/1 – 6/30), determined by the date of the activity. Expenses should be submitted as soon as possible, but no later than 7/31 following the expiring term.

Agency Name*
Your Name*
First Last
Email*
Address (for mailing reimbursement)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of loss-control activity*
- Training
- Conference/Meeting
- Policy Development
- Certification
Name of entity providing training/activity/service*
Title of activity*
Date of activity*
Total reimbursement amount requested*

*Each member is allocated $2,500 for the program. Your reimbursement amount is contingent upon what has already been expended from your Agency,
Please attach copy of receipt(s).*
Drop files here or

Max. file size: 50 MB.
Name
This field is for validation purposes and should be left unchanged.

Training and Risk Management Activity Reimbursement Request Form

Reimbursement Request Form