Future Ready Workforce Grant - Request for Reimbursement

This form must be completed MONTHLY to receive a reimbursement for student-intern payroll.

Please complete no later than the 5th of each month in order to receive timely reimbursements.

Submit one form per student intern.

Incomplete forms will be returned and are subject to late reimbursements.

Company Name *

Name of person completing this request *

Email Address *

Phone Number *

Student Intern's First Name and Last Initial *

What is this student's hourly pay rate? *

How many total hours were paid to this student this month? *

Monthly Reimbursement Requested *

Total hours x hourly rate (max $15/hour); program maximum $500 per student

Future Ready Workforce Grant - Request for Reimbursement

Fergus Falls Area Chamber of Commerce