Reimbursement Request - PT Legislative Impact Day Student Lodging

Thank you for attending PT Legislative Impact Day and submitting this form for student lodging.

Requirements and Other Details:

  • We will only reimburse for lodging for PT and PTA students from EWU, Spokane Falls, PNWU, and Whitworth for a Wednesday night overnight stay.
  • You must email a copy (or copies if you paid for multiple rooms) of your hotel receipt to in order for the reimbursement request to be complete.

This reimbursement request must be received by April 1, 2023.

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

We will reimburse electronically or a reimbursement check will be mailed to the name and address submitted on this form within 7-10 business days of APTA Washington receiving a completed reimbursement request.

Please email hotel receipt to Your request will not be complete until that receipt is received.

Contact Information

First Name

Last Name






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.