{"id":5582,"date":"2023-11-21T17:04:28","date_gmt":"2023-11-21T22:04:28","guid":{"rendered":"https:\/\/studentsuccess-wds-dev.utk.edu\/urf\/?page_id=5582"},"modified":"2026-07-24T13:13:41","modified_gmt":"2026-07-24T17:13:41","slug":"faculty-supplies-reimbursement-request-form","status":"publish","type":"page","link":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/","title":{"rendered":"Faculty Supply Stipend &#8211; Reimbursement Request Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_157' ><form method='post' enctype='multipart\/form-data'  id='gform_157'  action='\/urf\/wp-json\/wp\/v2\/pages\/5582' data-formid='157' novalidate>\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"110\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LePoDYqAAAAAPZw_ZEQNzru8gG6y98pDNXbV_C4' data-tabindex='0'><input id=\"input_2c417a26a52cd4877909a376cec9243a\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_2c417a26a52cd4877909a376cec9243a\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_157' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_157_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Where possible, please collect receipts up to $250 and submit only one form by the deadline.<\/h3><\/div><fieldset id=\"field_157_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Faculty Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_157_1'>\n                            \n                            <span id='input_157_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_157_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_157_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_157_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_157_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_157_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_157_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Faculty UTK Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_157_2_container'>\n                                <span id='input_157_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_2' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_2' id='input_157_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_157_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_157_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_157_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_42'><span class='gform-field-label__text'>Faculty Personnel Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_157_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_5'><span class='gform-field-label__text'>Faculty Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_157_5' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_157_29\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Student Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_157_29'>\n                            \n                            <span id='input_157_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_157_29_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_29.3' id='input_157_29_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_157_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_157_29_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_29.6' id='input_157_29_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_157_31\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Student UTK Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_157_31_container'>\n                                <span id='input_157_31_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_31' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_31' id='input_157_31' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_157_31_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_31_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_31_2' id='input_157_31_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_157_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Award Type<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_157_49'>\n\t\t\t<div class='gchoice gchoice_157_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='SDG-RA (Research Assistant)'  id='choice_157_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_157_49_0' id='label_157_49_0' class='gform-field-label gform-field-label--type-inline'>SDG-RA (Research Assistant)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_157_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='SDG-IR (Independent Research)'  id='choice_157_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_157_49_1' id='label_157_49_1' class='gform-field-label gform-field-label--type-inline'>SDG-IR (Independent Research)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_157_48\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Award Term<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_157_48'>\n\t\t\t<div class='gchoice gchoice_157_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Fall'  id='choice_157_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_157_48_0' id='label_157_48_0' class='gform-field-label gform-field-label--type-inline'>Fall<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_157_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Spring'  id='choice_157_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_157_48_1' id='label_157_48_1' class='gform-field-label gform-field-label--type-inline'>Spring<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_157_48_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Summer'  id='choice_157_48_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_157_48_2' id='label_157_48_2' class='gform-field-label gform-field-label--type-inline'>Summer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_157_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_17'><span class='gform-field-label__text'>Item(s) Purchased<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_157_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_19'><span class='gform-field-label__text'>Date(s) of Purchase<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_157_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_20'><span class='gform-field-label__text'>Cost of Purchased Item(s)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_157_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_44\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_44'><span class='gform-field-label__text'>Invoice or Purchase Receipt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2048000' \/><input name='input_44' id='input_157_44' type='file' class='large' aria-describedby=\"gfield_upload_rules_157_44 gfield_description_157_44\" onchange='javascript:gformValidateFileSize( this, 2048000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_157_44'>Max. file size: 2 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_157_44'><\/div> <\/div><div class='gfield_description' id='gfield_description_157_44'>Please combine multiple receipts into one document <\/div><\/div><div id=\"field_157_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_36'><span class='gform-field-label__text'>DASH Document Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_157_36' type='text' value='' class='large'  aria-describedby=\"gfield_description_157_36\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_157_36'>The original source document number that paid the invoice(s)<\/div><\/div><div id=\"field_157_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_37'><span class='gform-field-label__text'>Posting Date in DASH<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_157_37' type='text' value='' class='large'  aria-describedby=\"gfield_description_157_37\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_157_37'>The posting date of the original source document<\/div><\/div><div id=\"field_157_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_23'><span class='gform-field-label__text'>DASH Account String to be Reimbursed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_157_23' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_39'><span class='gform-field-label__text'>Additional Account String for Reimbursement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_157_39' type='text' value='' class='large'  aria-describedby=\"gfield_description_157_39\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_157_39'>If multiple types of costs are being reimbursed, please list them and the amount.<\/div><\/div><fieldset id=\"field_157_33\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Business Manager Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_157_33'>\n                            \n                            <span id='input_157_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_157_33_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_33.3' id='input_157_33_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_157_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_157_33_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_33.6' id='input_157_33_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_157_32\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Business Manager Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_157_32_container'>\n                                <span id='input_157_32_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_32' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_32' id='input_157_32' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_157_32_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_157_32_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_32_2' id='input_157_32_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_157_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_41'><span class='gform-field-label__text'>Business Manager Department or Unit<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_157_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_157_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Agreement Acknowledgment<\/h3><div class='gsection_description' id='gfield_description_157_15'>By submitting this reimbursement request form, I hereby acknowledge and agree to the following important terms and conditions:\n\n\n1) Compliance with University Spending Policies: \nI understand and accept full responsibility for adhering to all university policies governing expenditures. Any expenses claimed for reimbursement must strictly adhere to these policies.\n\n2) Reimbursement Deadlines: \nI am aware that reimbursements will only be processed during the same semester as my grant allocation. It is further understood that no reimbursements will be entertained outside of the program dates or after the conclusion of the fiscal year. I have consulted the university's policies for specific guidelines on purchase and delivery timing. \n\n3) Mandatory Form Completion and Approval: \nI recognize that completion and prior approval of this reimbursement form are prerequisites for any reimbursement to be issued.\n\n4) Compliance with Departmental Policies: I have communicated with my department and business manager the reimbursement process for these expenses.\n\nBy signing below, I affirm my understanding and acceptance of the above terms and agree to adhere to them in order to facilitate the reimbursement process.<\/div><\/div><div id=\"field_157_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_157_21'><span class='gform-field-label__text'>Signature Acknowledging Agreement<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_157_21' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_157' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_157' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_157' id='gform_theme_157' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_157' id='gform_style_settings_157' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_157' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='157' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='8nMkRbFjRWa12n1JHYnYOCXMaO+q79vsTpaUGR42pXyFx8lV53PYSQIEgUOLKTWhQd1e+AN7ffSTLpjzGsTPcHVnsGLoJlVXU2\/k\/nmzVUasTA0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_157' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_157' id='gform_target_page_number_157' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_157' id='gform_source_page_number_157' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":28,"featured_media":0,"parent":3116,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-5582","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships\" \/>\n<meta property=\"og:url\" content=\"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Office of Undergraduate Research &amp; Fellowships\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-24T17:13:41+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/funding\\\/faculty-supplies-reimbursement-request-form\\\/\",\"url\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/funding\\\/faculty-supplies-reimbursement-request-form\\\/\",\"name\":\"Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/#website\"},\"datePublished\":\"2023-11-21T22:04:28+00:00\",\"dateModified\":\"2026-07-24T17:13:41+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/funding\\\/faculty-supplies-reimbursement-request-form\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/funding\\\/faculty-supplies-reimbursement-request-form\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/funding\\\/faculty-supplies-reimbursement-request-form\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"For Faculty\",\"item\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/faculty\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Faculty Funding\\\/Support for Undergraduate Research\",\"item\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/?page_id=3116\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Faculty Supply Stipend &#8211; Reimbursement Request Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/#website\",\"url\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/\",\"name\":\"Office of Undergraduate Research &amp; Fellowships\",\"description\":\"University of Tennessee, Knoxville\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/studentsuccess.utk.edu\\\/urf\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/","og_locale":"en_US","og_type":"article","og_title":"Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships","og_url":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/","og_site_name":"Office of Undergraduate Research &amp; Fellowships","article_modified_time":"2026-07-24T17:13:41+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/","url":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/","name":"Faculty Supply Stipend - Reimbursement Request Form - Office of Undergraduate Research &amp; Fellowships","isPartOf":{"@id":"https:\/\/studentsuccess.utk.edu\/urf\/#website"},"datePublished":"2023-11-21T22:04:28+00:00","dateModified":"2026-07-24T17:13:41+00:00","breadcrumb":{"@id":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/funding\/faculty-supplies-reimbursement-request-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/studentsuccess.utk.edu\/urf\/"},{"@type":"ListItem","position":2,"name":"For Faculty","item":"https:\/\/studentsuccess.utk.edu\/urf\/faculty\/"},{"@type":"ListItem","position":3,"name":"Faculty Funding\/Support for Undergraduate Research","item":"https:\/\/studentsuccess.utk.edu\/urf\/?page_id=3116"},{"@type":"ListItem","position":4,"name":"Faculty Supply Stipend &#8211; Reimbursement Request Form"}]},{"@type":"WebSite","@id":"https:\/\/studentsuccess.utk.edu\/urf\/#website","url":"https:\/\/studentsuccess.utk.edu\/urf\/","name":"Office of Undergraduate Research &amp; Fellowships","description":"University of Tennessee, Knoxville","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/studentsuccess.utk.edu\/urf\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/pages\/5582","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/comments?post=5582"}],"version-history":[{"count":2,"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/pages\/5582\/revisions"}],"predecessor-version":[{"id":6907,"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/pages\/5582\/revisions\/6907"}],"up":[{"embeddable":true,"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/pages\/3116"}],"wp:attachment":[{"href":"https:\/\/studentsuccess.utk.edu\/urf\/wp-json\/wp\/v2\/media?parent=5582"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}