UC Blue Ash: Student Group Reimbursement Form

This form is to request reimbursement from the UC Blue Ash College PNC Legacy Account. A receipt is required.

Name of Person Submitting Form

Email of Person Submitting Form

Phone Number of Person Submitting Form

Position of Person Submitting Form

Student Organization/Affinity Group

Reimbursement Amount Requested

The check should be made out to:

Please describe the reason for the expense and the items/services purchased.

Name of Advisor

Email of Advisor

Upload a photo or PDF of all receipts/invoices for which you are requesting reimbursement.