Mileage Reimbursement Application

If you are driving your personal vehicle to your CBL placement and it is outside of the Village of Canton, you MAY be eligible for mileage reimbursement up to a maximum of $100.

If this applies to you, please read over the Mileage Reimbursement Instructions below.

INSTRUCTIONS:

  1. Complete the Driver Transportation Waiver
  2. Complete and Submit the Mileage Reimbursement Application below

PLEASE BE ADVISED: applications are processed on a first come, first serve basis so funding is approved if funds are available. Please try and submit this to me before the deadline to give yourself a better chance at having your application approved.

Student Information
Course Information
Ex. EDUC
Ex. 101 or 355)
Ex. Introduction to CBL
Ex. Monday 2:00-4:00pm or Monday/Wednesday 2:00-4))pm
Transportation Information
Mileage Information
Ex. 68 Lawrence Avenue, Potsdam
Please be advised that the CBL office will only pay for 1 round trip per week.
Comments
Signature
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