Faculty Reimbursement Request Request reimbursement for any expenses to be charged to Infectious Disease accounts Date* MM slash DD slash YYYY Name* First Last Email* Phone Number* Address* Address for check to be mailed to (confirmation to reduce mailing errors)Reimbursement Type*Grant FundedCME Stipend/Faculty AllowanceMD/APP Required expensesOther1. CME Stipend/Faculty Allowance – Annual stipend allocated to faculty for CME/Professional Development. AY24 is budgeted at $1,000 per faculty per year. These funds cannot be rolled over to future years. 2. MD/APP Required Expense – The Section will reimburse physicians and APPs for the following expenses: Massachusetts Controlled Substance Registration, Drug Enforcement Administration (DEA) License Renewal, Board of Registration License Renewal, & Credentialing fees. 3. Other– Reimbursement on an account other than what's listed above. For example, a Recruitment/Development account (a financial agreement between DOM and a faculty member to support their program development/research program). Account (nickname or project number)* Note that BMC project/grant number starts with a number 4, BU Internal Number starts with a 9Is Grant Manager aware of expense?*YesNoDescription of Expense*What is the expense? If research related - how does the expense benefit the project?Total Requested Reimbursement Amount (USD $)* Upload receipts and other confirmatory information* Drop files here or Select files Max. file size: 100 MB. All expenses require detailed receipts. If last 4 digits of card used are not visible on receipt, a bank or credit card statement (pending charges are allowed) is required.