AMICAL Grant-Funded Activities - Reimbursement Request

Reimbursement Request Form

AMICAL Grant-Funded Activities
Instructions (by activity type)
To see the relevant instructions, indicate the event or activity concerned by this reimbursement:
Activity type*

AMICAL ConferenceSmall Grant or other (non-AMICAL Conference)
Activity ID or title*
Small Grant ID or brief title of funded activity
Instructions (AMICAL Conference)

At the conference, submit to the event staff at the check-in/information desk all supporting documents requested below (institutional invoice OR original boarding passes, receipts, itemization of expenses, explanation of currency conversion, etc.).

If you are unable to provide all documents at the event, send the complete documentation after the event to:

American University of Paris
Attn: Jeff Gima / AMICAL
102 rue Saint Dominique
75007 Paris
FRANCE

If you are submitting an invoice for reimbursement to your institution (preferred method)

1. Before filling the form out, select your Form of Payment below. IF your invoice includes all bank/address information requested below, you do not need to submit this form.

2. Send to the address above a numbered, dated, itemized invoice on institutional letterhead and addressed to "American University of Paris" as payer. You may send this as an original (not scanned) electronic document to accounting@amicalnet.org, but keep the originals safely in case the they are requested by AUP Accounting.

3. Use this form to send additional requested information that is not already provided on your invoice.

If you are requesting reimbursement as an individual (or as an institution unable to invoice)

1. Complete and submit this form online.

2. Submit the following supporting documents, as appropriate:

Your boarding passes for outbound travel to conference. These should be either the printed boarding passes used, or born-digital boarding passes, but not scanned copies.

A receipt or e-ticket confirmation that shows the following:
- Name of traveler
- Amount paid for ticket (indicating currency used)
- Date of purchase
- Travel itinerary

(IF applicable) Receipts for any other expenses that you've been authorized to claim. These need to be original paper receipts that show:
- What was purchased (we can't accept credit-card charge slips that do not show what was purchased)
- Amount paid
- Date of purchase

(IF applicable) A Multiple Expense Itemization form

(IF applicable) A printout of your currency conversion calculation, using a tool like Oanda.com

(IF you choose not to complete this form online) A printed/completed/signed Reimbursement Request form

Multiple expenses to claim? (for reimbursement to individual)

If you are claiming more than a single expense (a single receipt), then you should also complete the Multiple Expenses Itemization form, print it, and submit it along with this form and your original receipts.

You may find it helpful to partially complete the present form up through "Expenses being reimbursed" before completing the Multiple Expenses Itemization form, to clarify the reimbursement currency.

Data security

This form data is transmitted, and viewed by AMICAL staff, using secure encrpytion. Your bank account number, if provided below, will be used solely for this reimbursement and will be deleted from the form processor shortly after the reimbursement has been successfully made.

Don't want to use the online form?

Using this online form will greatly expedite the processing of your request, but if you do not wish to enter the requested information online, you may print the form, complete it by hand, sign it, and send it with your supporting documents to the address above. In order to print the correct version, you should
- select your "Form of payment"
- select any other choices that affect which questions are displayed (e.g. Institution/Individual for wire transfers)
- click on "Print Form" at bottom

Payment turnaround time

Please allow for the following approximate turnaround times for your payment to arrive, depending on the mode of payment:
- wire transfer: 2-4 weeks
- check: 4-6 weeks
Requests submitted around the holiday periods of July-August or late December may take several weeks longer.

Questions? Email contact@amicalnet.org
Instructions

Any original/paper documents requested below should be sent to:

American University of Paris
Attn: Jeff Gima / AMICAL
102 rue Saint Dominique
75007 Paris
FRANCE

If you are submitting an invoice for reimbursement to your institution (preferred method)

1. Before filling the form out, select your Form of Payment below. IF your invoice includes all bank/address information requested below, you do not need to submit this form.

2. Send to the address above a numbered, dated, itemized invoice on institutional letterhead and addressed to "American University of Paris" as payer. You may send this as an original (not scanned) electronic document to accounting@amicalnet.org, but keep the originals safely in case the they are requested by AUP Accounting.

3. Use this form to send additional requested information that is not already provided on your invoice.

If you are requesting reimbursement as an individual (or as an institution unable to invoice)

1. Complete and submit this form online.

2. Send to the address above the following supporting documents:

Your boarding passes for related travel. These should be either the printed boarding passes used, or born-digital boarding passes, but not scanned copies.

A receipt or e-ticket confirmation that shows the following:
- Name of traveler
- Amount paid for ticket (indicating currency used)
- Date of purchase
- Travel itinerary

(IF applicable) Receipts for any other expenses that you've been authorized to claim. These need to show:
- What was purchased (we can't accept credit-card charge slips that do not show what was purchased)
- Amount paid
- Date of purchase

(IF applicable) A Multiple Expense Itemization form

(IF applicable) A printout of your currency conversion calculation, using a tool like Oanda.com

(IF you choose not to complete this form online) A printed/completed/signed Reimbursement Request form

Multiple expenses to claim? (for reimbursement to individual)

If you are claiming more than a single expense (a single receipt), then you should also complete the Multiple Expenses Itemization form, print it, and submit it along with this form and your original receipts.

You may find it helpful to partially complete the present form up through "Expenses being reimbursed" before completing the Multiple Expenses Itemization form, to clarify the reimbursement currency.

Data security

This form data is transmitted, and viewed by AMICAL staff, using secure encrpytion. Your bank account number, if provided below, will be used solely for this reimbursement and will be deleted from the form processor shortly after the reimbursement has been successfully made.

Don't want to use the online form?

Using this online form will greatly expedite the processing of your request, but if you do not wish to enter the requested information online, you may print the form, complete it by hand, sign it, and send it with your supporting documents to the address above. In order to print the correct version, you should
- select your "Form of payment"
- select any other choices that affect which questions are displayed (e.g. Institution/Individual for wire transfers)
- click on "Print Form" at bottom

Payment turnaround time

Please allow for the following approximate turnaround times for your payment to arrive, depending on the mode of payment:

wire transfer: 2-4 weeks
check: 4-6 weeks
Requests submitted around the holiday periods of July-August or late December may take several weeks longer.

Questions? Email contact@amicalnet.org
Grant Beneficiary
Enter here information about the individual whose expenses are being reimbursed, or the person responsible for the grant-funded project:
Full Name*

First NameLast Name
E-mail*

Confirmation Emailexample@example.com
Phone Number

Country CodeArea CodePhone Number
Form of Payment
If your bank is in the US or can accept a check in USD, we can send your reimbursement in the form of a check in US dollars, sent to you by normal postal service (air mail).

Otherwise, you may select wire transfer and enter the full details of your bank below.
Form of payment requested*

USD checkWire transfer (EUR or USD)

USD Check
USD Check
Please note that we are only able to send checks by normal postal airmail service.
Name of check recipient*
(to the order of...)
Address to which check should be sent

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

END USD Check

Wire Transfer
Wire Transfer: Bank
Bank Name*
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
BIC/SWIFT code*
ABA Routing Number*
Intermediary/ correspondent bank?

Tick here to enter details for an intermediary/correspondent bank
Correspondent Bank Name*
Correspondent Bank BIC/SWIFT code*
Wire Transfer: Bank Account & Account Holder
Enter bank account information below for the institution or individual receiving the reimbursement payment:
Account holder is an*

InstitutionIndividual
Select your institution from one of the following lists. The lists are separated according to whether AUP has been able to make make successful payments in euros or in US dollars in the past.
Institution (EUR payment)
Institution (USD payment)
IBAN code
Account Number*
Name of Account Holder*
Address of Account Holder

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

END Wire Transfer
Expenses being reimbursed
Enter the date of the expense (or the last of this group of expenses) being claimed for reimbursement:
Date of last expense/purchase*

DayMonthYear
Enter below the amount to be reimbursed (not to exceed amount in the email notifying you of your award/support).

If your purchase was in a currency different from the currency shown below, you should calculate the equivalent total in the currency below (e.g. using a tool such as Oanda) and enter the converted amount below. Upload a screenshot or PDF of the calculated conversion below, or print it out and submit with other supporting documents.
Reimbursement amount (EUR)*
Round to nearest whole euro, no decimal
Reimbursement amount (USD)*
Round to nearest whole dollar, no decimal
Purchases in currency different from reimbursement currency?

Yes
Currency conversion calculation

You may upload more than one file
Cancelof
Includes multiple expenses?

Yes
If you have multiple expenses to claim, see instructions at top. Download this itemization form template to list each expense, then upload the completed form below (or print it and submit with other supporting documents).
Itemization form

Cancelof
You may submit an electronic copy of an air/train/bus/etc. fare receipt or other documentation requested by AMICAL.
Attaching documentation (receipts, etc.)?

Yes
Make sure that any fare receipt you submit shows your name, travel itinerary and dates, the amount paid, and the date purchased.
I'm submitting my documentation by

Email to accounting@amicalnet.orgUpload here
Documentation

You may upload more than one file
Cancelof
Comments / Questions
Certify:*

I certify that all information entered above is true and reflects actual expenses directly related to the grant-funded activity proposed to AMICAL.
Please sign below (using mouse/touch/stylus/etc.):
Signature*
Receipts sent separately

Waiting onReceivedOther
After submitting the form you will be taken to a “Thank you!” page, indicating that the submission was successful. If you do not reach this page, then something has gone wrong. Consult our troubleshooting document to find out how to proceed.
Should be Empty:

Reimbursement Request Form

Instructions (by activity type)

Grant Beneficiary

Form of Payment

USD Check

Wire Transfer: Bank

Wire Transfer: Bank Account & Account Holder

Expenses being reimbursed