Intern Grant 2025 - Request for Reimbursement

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

Please complete no later than the 1st 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 and Last Name *

Is this intern a W-2 employee? *

Yes No

Is this intern working in a STEM career field? *

Yes No

STEM (Science, Technology, Engineering and Math)

Position/Role of Student Intern (type of job/career)

What is this student's hourly pay rate? *

Request for onboarding or student support expense reimbursement. Please list item(s) and expense amount(s).

How many total hours did student intern work this month? *

Monthly Reimbursement Requested *

Total hours x hourly rate (max reimbursement $15/hour). $500 max total reimbursement for most internships.

Intern Grant 2025 - Request for Reimbursement

Fergus Falls Area Chamber of Commerce

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