Reimbursement Request Form

Important:

Reimbursements may take 2-3 weeks to be processed.
Include the best mailing address to reach you. MIT campus mailing addresses are valid.
MIT will not reimburse for sales tax.
Please enter 1747202 in the Account to Charge field.
Receipts must display your name and indicate the item was paid for. An invoice that displays a due balance but no record of payment will not be accepted.
The following expense types require written approval from L&L staff before submitting this request form. Approval can be obtained by emailing laureatesleaders@mit.edu. Requests submitted without prior approval will not be processed.
- Conference Registration Fee
- Conference Travel
- Other

Questions about this form? Email laureatesleaders@mit.edu.

First Name

Last Name

MIT Email

Class of

For example, 2022

US Citizen or Permanent Resident

Yes

Country of Citizenship

I have direct deposit setup via Atlas

Yes, I have direct deposit setup in Atlas.

No, I do not have direct deposit setup in Atlas. I understand a paper check will be mailed to the address I provide below.

Mailing address (please provide even if you have direct deposit setup)

Please use a mailing address that you can receive mail at for up to 3 weeks after submission of this form. Campus addresses are valid.

I am submitting multiple reimbursement requests on this form. (Maximum = 3)

No, I am submitting only 1 reimbursement on this form.

Yes, I will submit 2 reimbursements on this form.

Yes, I will submit 3 reimbursements on this form.

Account to charge:

Please enter 1747202