Incidentals Reimbursement Form

INSTRUCTIONS:

Review your Student/Host Family Handbook for full details of student finances before submitting this request. Incidentals are available for specific types of costs on a reimbursement-only basis. Whether the student paid for these or the host family, $300 is the total amount allotted per FLEX or YES student.
Receipts must be submitted with this form.

Please allow 3-4 weeks to receive a reimbursement. Reimbursements may be made by check or ACH (electronic bank transfer). If you are interested in ACH reimbursement, we will request some information from you. We strongly encourage using ACH.

Students will be reimbursed through their personal bank cards.

After familiarizing yourself with guidelines for reimbursement, please contact the International Student Support Team at inbound@americancouncils.org with questions.

Today's date: (MM/DD/YYYY)

Student Name

Program

Host Family Name

Local Coordinator Name

Who is the reimbursement being paid to?

Name of person to be reimbursed:

You will be reimbursed directly to your Student Bank Card. If there is an issue with your card, describe below. If not, continue with the form.

Preferred Payment Method

ACH/Electronic TransferCheck

Have you received an ACH/Electronic Transfer from us in the past?

YesNo

Has your banking information changed?

YesNo

Payment Information

If you are requesting an ACH/Electronic Transfer for your reimbursement, please download and complete the form linked here and upload it below. If you do not submit the form with all information, your reimbursement will be processed with a check.

Click Here for the fillable ACH Request Form.

Information on this form is treated as sensitive data and will not be shared outside of this organization.

ACH Information

How many receipts are you submitting?

To submit more than one receipt, click "CLICK HERE TO ADD ANOTHER RECEIPT" bottom right of receipt box. There is no limit.

Receipt