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. If you will be driving other students in your personal car, all students must fill out a Rider Transportation Waiver
  3. Complete and Submit the Mileage Reimbursement Application below

PLEASE BE ADVISED: applications are processed on a first come, first serve basis (after all waivers listed below are received) 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 (if for Community Mentor staff, please enter CBL)
Ex. Introduction to CBL (if for Community Mentor staff, please enter community partner name)
(If for Community Mentor staff, please enter staff supervisor)
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
By typing in your name below you certified that all the information stated is correct.