2021-2022 JusticeCorps Public Transit Reimbursement Form
Use this form to request reimbursement for travel to and from JusticeCorps service and training. Upon submission of this form, JusticeCorps program staff will issue and mail you a Clipper Card based on your total expenses. Members will only need to submit this form once if all trips to/from service thereafter are debited to the Clipper Card issued by JusticeCorps. Members should not use this card for any trips unrelated to their service. Once the funds issued onto the card fall below $10, members should contact Jake Jimenez <jjimenez2@alameda.courts.ca.gov> to reload their card back to their “capital outlay” or “base amount” of funds.
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Name: *
Travel Route 1: Origin and Destination, Mode of transport (and Parking when Applicable) *
Enter the origin and destination of your most common route here. Include: mode of transport (BART/MUNI/CalTrain) and any parking. FOR EXAMPLE:  "Dtwn Berkeley BART to Lake Merritt BART & Parking"
Travel Route 1: Round Trip Cost and Dates *
Enter the round trip cost for one trip on this route and  all the dates you took this route. FOR EXAMPLE: "$3.50 plus $1 Parking (9/10, 9/12, 9/17, 9/19, 9/24, 9/26)"
Travel Route 2: Origin and Destination, Mode of transport (and Parking when Applicable)
Enter the origin and destination of a 2nd route here (If any). Include: mode of transport (BART/MUNI/CalTrain) and any parking. FOR EXAMPLE:  "Dtwn Berkeley BART to Civic Center BART & Parking"
Travel Route 2: Round Trip Cost and Dates
Enter the round trip cost for one trip on this route and  all the dates you took this route. FOR EXAMPLE: "$7.40 plus $1 Parking (9/8, 9/9)"
Additional Routes: Round Trip Cost and Dates
Enter the round trip cost for all trips that were not on Route 1 or Route 2, including the cost for these trips and the corresponding dates. FOR EXAMPLE: "Dtwn Berkeley BART to Hayward BART, $7.40, on 9/25 & 10/15"  and "Dtwn Berkeley BART to Oakland City Center BART, $3.50, on 10/9"
Net or Total Cost of All Fares Listed Above: *
Mailing Address:
Please enter the address that you would like your Clipper Card to be mailed to.
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