Mead Endowment Disbursement Request

Use this form to request disbursement of Mead Endowment funds.

Please select your status from the following:(Required)

New faculty member (eligible for Boots Bucks)

Mead Honored faculty

Newly-tenured faculty

Dream On faculty

Other

If you are interested in being reimbursed for an engagement expense and you do not fall into one of the above categories, please email us at meadendowment@virginia.edu.

Contact Information

Your Name:(Required)

First Last

Mailing Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Email Address:(Required)

Your Phone:(Required)

Amount:(Required)

Reimbursement Information

Pay to

If left blank, payment will be made out to your name

Who is the reimbursement recipient?(Required)

Delivery Method: Direct Deposit
Individual reimbursements are done via direct deposit. We will be in touch if we do not already have information on file for the selected recipient.

Payment Method(Required)

Delivery Method: Direct Deposit
We will be in touch if we do not already have information on file for the selected recipient.

Vendor Address(Required)

Street Address Address Line 2 City State ZIP Code

Receipts:(Required)

Drop files here or

Accepted file types: pdf, jpg, gif, png, bmp, doc, docx, Max. file size: 1 MB.

Are these expenses considered allowable under University and IRS guidelines?(Required)

Yes

Please explain why these expenses are not considered allowable.(Required)

Comments

Enter any comments or additional information here.

Authorization(Required)

I affirm I am authorized to request this disbursement and that this request meets all applicable rules and guidelines.