Grace is at work, even in your hardest moments
Travel Reimbursement Form
If this is your first time to request a reimbursement, you must fill out the Grant Application first.
NOTE: Every time you travel for treatment, you must complete a Travel Reimbursement form and submit it, along with the corresponding receipts. If you have any questions, please email us or call Ashley at 334-748-2213.
HOW TO REQUEST REIMBURSEMENT:
If this is your first time to request reimbursement, please click here to fill out the Grant Application.
You only need to do this once.Snap a picture or scan your receipts.
NOTE: As of May 6, we are no longer reimbursing for food, but you will need receipts for all other reimbursement items. Upload these in the form.Treatment Plan - You will need to upload a copy of your treatment summary or doctor's note that includes your name and treatment date.
Dates - you will need dates of your travel.
Payment type - We will need your Venmo handle or PayPal email address.
Click below to access our secure JotForm.