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Health Professions Scholarship Program _HPSP_

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					 Health Professions
 Scholarship Program (HPSP)

How To Submit A Reimbursement
Army
Steps for completing reimbursement
• Print off the Medcom Form 678-R found at
  http://www.atsu.edu/registrar/military.htm
• Fill in the top section with the student and
  institution information
• If claiming Health Insurance, Vaccinations,
  USMLE fees, and Eras Fees complete Item 12
  with dates claimed and cost
• Enter total
Army
Steps for completing reimbursement
• Enter Required Textbooks/ Author, Equipment
  and Supplies in Item 13
• Enter Date of Purchase and Cost in appropriate
  columns
• Add up sales tax and enter on Total Taxes for
  Item 13 Line
• Add total of books to sales tax and enter in the
  Total column for Item 13
• Enter Grand Total Items for 12 and 13
• Sign the form
Army
Steps for completing reimbursement
• Attach your receipts with the form. If using small
  receipts from the bookstore please tape them
  to a blank sheet of white paper. You do not
  need to include the actual credit card processing
  receipt.
• Deliver, mail, or fax to the Record’s Coordinator in
  the Registrar’s Office.
• We will check forms to make sure it contains only
  reimbursable items, sign and forward to the Army
  for reimbursement.
• Please make copies of all forms and receipts for your
  records.
Navy
Steps for completing reimbursement
• Print off the Dean’s Certificate and Standard Form 1164 found
  at http://www.atsu.edu/registrar/military.htm
• Complete student and university information at the top of the
  Dean’s Certificate. We will complete the rest of that form.
• On Standard Form 1164, complete the top portion for the
  Claimant information
• Enter all expenditures in the expenditure portion of the form.
  Enter date (A), items you are claiming in the C and D columns
  and enter the cost in the Mileage (F) column.
• If needed, continue on back of form and carry totals over to
  the front in the Subtotals Carried Forward from the Back
  column.
Navy
Steps for completing reimbursement
• Enter sales tax and label it on one of the lines.
• Enter total amount claimed on line 7 Amount
  Claimed.
• Sign and date the form in section 10.
Navy
Steps for completing reimbursement
• Attach your receipts with the form. If using small
  receipts from the bookstore please tape them
  to a blank sheet of white paper. You do not
  need to include the actual credit card processing
  receipt.
• Deliver, mail, or fax to Record’s Coordinator in the
  Registrar’s Office.
• We will check forms to make sure it contains only
  reimbursable items, sign and forward to the Navy
  for reimbursement.
• Please make copies of all forms and receipts for your
  records.
Air Force
Steps for completing reimbursement
• Print off the AFIT Form 31 found at
  http://www.atsu.edu/registrar/military.htm
• Complete form and forward to the Air Force. Air
  Force students do not turn anything into the
  Registrar’s Office and their forms do not require
  the Registrar’s signature (Navy & Army do).
Please remember the following tips:

• Please submit health insurance for
  reimbursement each time the premium is
  paid.
• Only items for reimbursement should be
  included on receipts submitted with
  reimbursement form. Purchase other non-
  reimbursable items in a separate
  transaction.
• Forms can be found at
  http://www.atsu.edu/registrar/military.htm
     Registrar’s Office Contact
            Information
• Laura Brummitt- Records Coordinator
 ▫ Processes all HPSP Reimbursement Claims
                          ATSU
                 Office of the Registrar
                800 W. Jefferson Street
                 Kirksville, MO 63501
                 Phone 660.626.2356
                   Fax 660.626.2926
                 lbrummitt@atsu.edu
                  registrars@atsu.edu

				
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posted:4/12/2013
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