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ATLAS Invoice
NOTE
: If you need reimbursement for
Adult Diploma (ADP Working Group), ABE Managers, Program Improvement,
or
Statewide PD Committee
meetings/activities, or the
ABE Summer Institute
, please go to the
Literacy Action Network website
.
Submitter Information
This is the person submitting the invoice - which may be the same or different from the PAYEE.
Date of Submission
*
MM slash DD slash YYYY
Your Name
*
First
Last
Your Email
*
Enter Email
Confirm Email
Your Phone
*
Payee Information
The PAYEE is the individual or organization to whom the check will be written. NOTE: We cannot pay you unless you have a Form W-9 on file with Hamline. Please see https://atlasabe.org/submit-invoice/ for information and instructions.
Are you submitting this invoice on behalf of another person or organization that should receive the payment?
*
Yes
No; I am the payee and should receive this payment.
Name of PAYEE (who will receive the payment)
*
Email of PAYEE (who will receive the payment) or payee's representative
*
Enter Email
Confirm Email
Address of PAYEE (who will receive the payment)
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is this a new/updated address for this PAYEE?
*
Yes
No
Unsure
Is the PAYEE an employee of Hamline University?
*
No, the payee is not employed by Hamline
Yes, the payee is Hamline staff
Yes, the payee is Hamline regular faculty
Yes, the payee is Hamline adjunct faculty
Has the PAYEE ever been paid by ATLAS / Hamline University previously?
*
If NO, then a Form W-9 must be submitted. For instructions, go to https://atlasabe.org/submit-invoice/
Yes
No
A) Mileage Reimbursement
Fill out if applicable. NOTE: Mileage only reimbursed for trips of 50 miles or more one-way.
TRIP INFORMATION - ALL boxes are required
(Click PLUS SIGN to enter your RETURN TRIP; be sure to claim BOTH one-way trips!)
Travel Date (mm/dd/yy)
Reason for Travel (e.g., North Regional)
From (city)
To (city)
Miles (ONE-WAY)
Mileage Rate (.56 for 2021)
AMOUNT
Total Mileage Reimbursement
(automatic calculation)
B) Reimbursable Expenses (receipts required)
Fill out if applicable. Examples include hotel, airfare, supplies, photocopies, etc. NOTE: Meals are usually NOT reimbursable; please check first with ATLAS staff.
EXPENSE INFORMATION - ALL boxes are required
(Click PLUS SIGN to add more rows)
Date(s) of Expense
Description/Reason for Expense
Amount $
UPLOAD RECEIPTS
* A RECEIPT IS REQUIRED FOR EACH EXPENSE. Multiple receipts may be uploaded. Maximum file size is 100MB.
Drop files here or
Select files
Max. file size: 128 MB.
Total Expense Reimbursement
(automatic calculation)
C) Stipends / Contract Payments
Fill out if applicable. Examples include presenter/facilitator fees, cohort participant stipends, study circle participant stipends, contract work, etc.
PAYMENT INFORMATION - ALL boxes are required
(Click PLUS SIGN to add more rows)
DATE(s) of Service / Activity
Description of Activity / Reason for Payment
Amount $
Total Stipend/Contract Payments
(automatic calculation)
Before Submitting Invoice
Please check to make sure all required information is included. Thank you!
Do you have any special instructions or comments regarding this invoice?
TOTAL PAYMENT
*
(automatic calculation)
ELECTRONIC SIGNATURE: By typing my initials below, I certify that all information submitted herein is accurate and truthful.
*
MILEAGE REMINDER: Did you claim BOTH one-way trips? (instructions are above)
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