PT Legislative Impact Day Mileage & Parking Reimbursement Form

Thank you for attending PT Legislative Impact Day and submitting this form for mileage and parking reimbursement.

Requirements and Other Details:

Only PT and PTA students from Western Washington and PNWU may be reimbursed for mileage and parking.
The PT or PTA student must be the driver of the vehicle.
Mileage and parking expense must be incurred on January 26, 2023 (may include January 25 if you are from PNWU).
At least four people who are attending PT Legislative Impact Day (including the driver being reimbursed) must be transported in the vehicle. Only the driver needs to be a student.

This reimbursement request must be received by April 1, 2023 (not a joke).

If you have any questions about filling out this form or the requirements, please contact info@aptawa.org or call (800) 554-5569.

An electronic reimbursement will be issued or a check will be mailed to you within 7-10 business days of APTA Washington receiving a completed reimbursement request.

School Name:

Mileage Starting Address

Mileage Final End Address

Total Mileage Requested

If total mileage amount is not requested, PTWA will calculate your mileage based on direct route travel between your starting address and final end address listed above.

Names of ALL Passengers/LID Attendees (Must be 4+ passengers)

Amount Paid for Parking

Please email parking receipt to info@aptawa.org, if it is available.

Contact Information

First Name

Last Name

Address

City

State

Zip

Home Phone

By submitting this form, I attest that I meet all of the requirements as specified above and the information I am submitting is correct to the best of my knowledge.

Submit