UAW 4121 Elected Rep Reimbursement Form

UAW 4121 Elected Representative Reimbursement Form
UAW 4121 members approved funds for stewards and other elected leaders to host groups of members for meetings or other activities focused on union engagement. Each representative can use up to $50 per quarter for this purpose. Common uses include purchasing refreshments for meetings, printing materials, or reserving space. If you ever have any questions about what funds can be used for, please email uaw4121@uaw4121.org.

This form has a few questions to answer. At the end you will need to attach these things:
1. The sign-in sheet from your meeting (photo or scanned copy)
2. Receipts for the items you purchased (electronic receipts or scans of paper receipts) --please upload individually

After you've submitted everything, please email uaw4121@uaw4121.org to let our office manager know!
Name (first + last)*
Where should we mail the check?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Department / Hiring Unit
Date of event*

MonthDayYear
Date
Total number of attendees?
Are you combining your quarterly allowance with other stewards/ elected reps? If so, please list first and last names for each.
Please upload sign-in sheet*

Cancelof
Please upload receipt (if uploading multiple receipts, please upload separately below): *

Cancelof
Expected reimbursement amount (up to $50 per Steward):

$50 (1 steward)$100 (2 stewards)$150 (3 stewards)$200 (4 stewards)My total reciept is less than $50 per steward
Should be Empty:

UAW 4121 Elected Representative Reimbursement Form