FCNL Visiting Friends Program Reimbursement Request Form (2022)
Please use this form to calculate your reimbursement request for Visiting Friends travel. The first time you request reimbursement, please fill out an FCNL ACH Authorization Form and a Form W9 along with this reimbursement request form. Return all completed forms and itemized receipts to Bobby (rtrice@fcnl.org) to receive reimbursement. Preferred: If possible, please submit your reimbursement request and upload itemized receipts when submitting your VF visit report online: fcnl.org/vfreport.
Reimbursement Policy
Reimbursement for travel costs to three (3) FCNL Visiting Friend visits in the total amount of $700 per year will be made available from FCNL to current Visiting Friends as recommended by the Quaker Outreach Coordinator and approved by the Director of Quaker Leadership. If you are led to complete more than three (3) visits per year or there are other extenuating circumstances indicating a need for increased reimbursement, please reach out to FCNL staff. We cannot reimburse expenses greater than $700 per year unless you have consulted with FCNL staff. Reimbursement will not be provided for virtual “travel.” FCNL recognizes that many Visiting Friends cover some or all their own expenses as an additional contribution to FCNL and does not seek to alter that practice. Receipts and a completed reimbursement request form must be provided to receive reimbursement.
(I) Visiting Friend Information
•	Name: _____________________
•	Address: ___________________
•	Phone: _____________________
•	Date of visit: ________________
•	Meeting or church visited: ________________________
(II) Reimbursement Calculation
Expense Category	Amount	
Travel by air/train/bus 		
Local bus/taxi/rideshare		
Travel by personal vehicle: (No. of miles ___ @ $0.585/mile=)		
Travel by rental car		
Gas		
Parking		
Lodging 		
SUBTOTAL		
Amount to be reimbursed from other sources, if any: 
Source: _______________________________ $ ________		
TOTAL REIMBURSEMENT REQUESTED