Health Professions Scholarship Program (HPSP) How To Submit A Reimbursement

Army Steps for completing reimbursement Print off the Medcom Form 678-R found at http://www.atsu.edu/registrar/military.htm Fill in the top section with the student and institution information If claiming Health Insurance, Vaccinations, USMLE fees, and Eras Fees complete Item 12 with dates claimed and cost Enter total

Army Steps for completing reimbursement Enter Required Textbooks/ Author, Equipment and Supplies in Item 13 Enter Date of Purchase and Cost in appropriate columns Add up sales tax and enter on Total Taxes for Item 13 Line Add total of books to sales tax and enter in the Total column for Item 13 Enter Grand Total Items for 12 and 13 Sign the form

Army Steps for completing reimbursement Attach your receipts or copies of receipts to your claim. If using small receipts from the bookstore please tape them to a blank sheet of white paper. You do not need to include the actual credit card processing receipt. Attach the required book list to your claim. The required book list will be available on the Registrar’s webpage after the beginning of each quarter. This book list is not to be used as a shopping list but is needed with submission of your claim. Deliver, mail, or fax to the Record’s Coordinator in the Registrar’s Office. We will check forms to make sure it contains only reimbursable items, sign and forward to the Army for reimbursement. Please make copies of all forms and receipts for your records.

Navy Steps for completing reimbursement Print off the Dean’s Certificate and Standard Form 1164 found at http://www.atsu.edu/registrar/military.htm Complete student and university information at the top of the Dean’s Certificate. We will complete the rest of that form. On Standard Form 1164, complete the top portion for the Claimant information Enter all expenditures in the expenditure portion of the form. Enter date (A), items you are claiming in the C and D columns and enter the cost in the Mileage (F) column. If needed, continue on back of form and carry totals over to the front in the Subtotals Carried Forward from the Back column.

Navy Steps for completing reimbursement Enter sales tax and label it on one of the lines. Enter total amount claimed on line 7 Amount Claimed. Sign and date the form in section 10.

Navy Steps for completing reimbursement Attach your receipts or copies of receipts to your claim. If using small receipts from the bookstore please tape them to a blank sheet of white paper. You do not need to include the actual credit card processing receipt. Attach the required book list to your claim. The required book list will be available on the Registrar’s webpage after the beginning of each quarter. This book list is not to be used as a shopping list but is needed with submission of your claim. Deliver, mail, or fax to Record’s Coordinator in the Registrar’s Office. We will check forms to make sure it contains only reimbursable items, sign and forward to the Navy for reimbursement. Please make copies of all forms and receipts for your records.

Air Force Steps for completing reimbursement Print off the AFIT Form 31 found at http://www.atsu.edu/registrar/military.htm Complete form and forward to the Air Force. Air Force students do not turn anything into the Registrar’s Office and their forms do not require the Registrar’s signature (Navy & Army do). The required book list for each quarter, insurance is required letter and required supply list will be available on the Registrar’s webpage after the start of each quarter.

Please remember the following tips: Please submit health insurance for reimbursement each time the premium is paid. Only items for reimbursement should be included on receipts submitted with reimbursement form. Purchase other non- reimbursable items in a separate transaction. Forms can be found at http://www.atsu.edu/registrar/military.htm

KCOM SAMOPS LIAISONS Army- Stephanie Sutthoff Navy- Ed Weimholt Air Force- Brittaini McGinnis