County/MA Site Post Travel Reimbursement Request Your Name* Your Email* Position Title* Organization* Phone* Details* Please provide the following for each participant you would like reimbursement for: 1.) Participant Name(s) 2.) Title of the course(s) attended 3.) Date(s) attended 4.) Completed Reimbursement Packet (see attachment area below) Total Dollar Amount Requested* I understand, Reimbursement will be made to an organization (county or MA site), not an individual. I understand that all requested travel documentation must be submitted within 2 weeks of course completion in order to be reimbursed. I certify that the statements in this request are true and just in all respects; that payment of the amounts claimed herein has not and will not be reimbursed to me from any other source(s); that travel performed for which advance/reimbursement is claimed was or will not be performed by me for Training Provided by the State and that no claims are included for expenses of a personal or political nature or for any other expenses not authorized by the Fiscal Rules; and that I actually incurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileage basis.