IPSA Expenditure Pre-Approval

   Request Form Instructions

 

  1. Indicate for which organization you are submitting a request.
  2. Event: Tell us how you will be spending this money. We provide an accounting of how grant funds are spent to the granting organization. This will help us to compile an annual report of our spending.
  1. Person requesting should be the person who will make the purchase and subsequently receive reimbursement. If you are a program President/Director and are submitting a request on behalf of another program member, please indicate this in the provided space.
  1. Department/School: Through which professional school (ie SOM, SON, Allied Health) is your program organized.
  1. Amount requested: please coordinate with the IPSA Treasurer to ensure the balance on your promised funds. Do not request reimbursement beyond the remaining balance for your program.
  1. Items to be purchased: Please provide a detailed list describing the items that will be purchased. IPSA funds are approved for very specific purchases and we want to ensure that funds are used appropriately. If the complete list will not fit on the form, please submit an additional list with the request. Ideally, you should provide an invoice, if possible, for the intended purchase. This list and amount requested should match the Reimbursement Request Form.
  1. Estimated Attendance: please indicate how many students will participate in the event for which the funds are requested. Administration likes to receive a list of those in attendance for particular events to demonstrate that the funding is used in an interprofessional environment. If the funds will be used for multiple events, please indicate in the space provided.
  1. Signature of Program Faculty Advisor: You must either submit email confirmation from the Faculty Advisor associated with your program or include their signed approval on the form at the time of submission. This is to ensure accountability to the Faculty Advisor and ensure that the Faculty Advisor is aware of use of IPSA funding.
  1. This form should be submitted at least 2 weeks prior to purchase to allow for pre-approval. We want to ensure that intended purchases are included in the scope of grant and school funding.
  1. The IPSA Treasurer will review all applications to ensure that the request is complete, the requested funds meet the guidelines, and there are funds remaining.
  1. Following approval by the IPSA Treasurer, the request will be submitted to the CIPECP Director and Vice Chancellor for Academic Affairs for approval.
  1. Notice of approval will be sent via email, after which the purchase can be made. 

Pre-Approval Form Here

 

IPSA Expenditure Reimbursement

   Request Form Instructions

 

  1. Indicate for which organization you are submitting a request.
  2. Date of Expense: Please indicate when the purchase was made. In the remaining space indicate the date of the event for which the funds were used.
  1. Person requesting should be the person who will be receiving the reimbursement check. If you are a program President/Director submitting a request for a member of your organization, indicate this and ensure that the person receiving the reimbursement is specified in the “Reimbursement Payable to” space.
  1. Department/School: Through which professional school (ie SOM, SON, Allied Health) is your program organized.
  1. Dept. Address of Box #/Contact Person & Telephone: Please provide contact information for your Faculty Advisor. In the event that there are issues with the request or processing of the reimbursement, this person will be the on-campus point of contact.
  1. Account to be debited: Please leave this space blank. The IPSA Treasurer will review the reimbursement request and determine from which account the expense should be debited.
  1. Amount requested: please coordinate with the IPSA Treasurer to ensure the balance on your promised funds. Do not request reimbursement beyond the remaining balance for your program.
  1. Reason & Purpose of expense: Please give us a description of how the funds were used. We provide an accounting of how grant funds are spent to the granting organization. This will also help us to compile an annual report of our spending.
  1. Items to be purchased: Please provide a detailed list describing the items that were purchased.
    1. 2 COPIES OF PURCHASE RECEIPT(S) SHOULD BE SUBMITTED WITH REQUEST. FAILURE TO SUBMIT A RECEIPT WILL RESULT IN A DENIAL OF REQUEST. One copy should be the original receipt, the second a copy of the receipt to be kept on file. We also recommend keeping a copy of the receipt for your own records.
  1. Persons Attending: please indicate how many students participated in the event for which the funds are requested. Administration likes to receive a list of those in attendance for particular events to demonstrate that the funding was used in an interprofessional environment. Submit a list of students and their professional program so that we can confirm that funds have been used for an interprofessional event.
    1. Please note for food requests, reimbursement must have a full list of attendees.
  2. Place: Please indicate where the event was held (ie location on campus, off campus location)
  3. Reimbursement payable to: Please clearly print the full name of the person receiving the reimbursement check.
  4. Signature of Program Faculty Advisor: You must either submit email confirmation from the Faculty Advisor associated with your program or include their signed approval on the form at the time of submission. This is to ensure accountability to the Faculty Advisor and ensure that the Faculty Advisor is aware of use of IPSA funding.
  1. Please leave the bottom line of blanks empty for use by the IPSA Treasurer.
  1. The IPSA Treasurer will review all applications to ensure that the request is complete, the requested funds meet the guidelines, and there are funds remaining for the requesting program.
  1. Following approval by the IPSA Treasurer, the request will be submitted to the CIPECP Director and Vice Chancellor for Academic Affairs for approval.
  1. Notice of approval will be sent via email, after which the reimbursement request will be processed. Requests can take up to a month for processing, especially during holidays. You will be notified once the reimbursement check has been received by the IPSA Treasurer and is available for pick up.

Contact the IPSA Treasurer with any questions or concerns: Jacquelyn Hunter jhun12@lsuhsc.edu.

Reimbursement Form Here