Civic Engagement Fund Reimbursement Form Civic Engagement Fund Reimbursement Form First Name * Last Name * E-mail Address * Phone Number * Mailing Address Where Reimbursement Should Be Sent * Student ID/Employee ID Number (if applicable) Course Name Purpose of Reimbursement Civic Engagement Fund Other Transportation Fund (CarShare, Bus, Ride Share) Purpose of Reimbursement Course Number Course Faculty Contact (First and Last Name) Course Faculty Title Department Primary Academic School Arts and Sciences Arts and Sciences: University College Brown School Olin Business School Sam Fox School of Design and Visual Arts School of Engineering and Applied Science School of Law School of Medicine Type of Reimbursement Individual Department Additional Information Please Upload Receipts Here Drop a file here or click to upload Choose File Maximum upload size: 51.2MB If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit