Youth Activities Program - SEEK Mileage Reimbursement

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Once an event (or series of events, in the case of camps) is complete, please fill out this form to request reimbursement for the mileage traveled.

Based on the location of the event, you will be given a fixed amount to cover mileage, based on the IRS .585 cents per mile and the distance traveled for each event.

EACH EVENT MUST BE REQUESTED SEPARATELY. All requests submitted within a calendar month will be reimbursed via check at the start of the next month.

Email *

Full Name of Person Requesting Reimbursement (this is who will receive the check) *

Full mailing address *

Best contact number *

Mileage Reimbursement Request *

Pt. Defiance Zoo - 26 miles roundtrip - $15.21

Camp Sealth - 36 miles roundtrip - $21.06

NW Trek - 61 miles roundtrip - $35.69

Lakewood - 12 miles roundtrip - $7.02

How many round-trips did you make for this event? *

What event did your youth attend? *

Name(s) of the youth who attended

Attestation *

I, the above named person, attest that I provided transportation to and from the above stated event.

Required

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