ABVO/ACVO Reimbursement Request Form

The ACVO and ABVO provide for an online submission of expenses toward official meetings and activities. Board and committee members may submit for reimbursement using the below summary spreadsheet and online form. Additionally this form is to be used by resident submitting for reimbursement of up to $500 for their registration in the Basic Science Course or the ACVO Vision for Animals course. *Please note that the course being submitted for must have already been completed/attended.

Submit for reimbursement online using this online digital form. Complete the summary expense spreadsheet (in Excel) and attach the expense sheet and a digital file of all scanned receipts, and submit it to the ACVO office for review after the expense date has occurred.

Only complete requests will be processed, allow 2-3 weeks for payment receipt via check. Please contact the ACVO with any questions.

Name of Diplomate or ABVO Approved Resident: Name of Diplomate or ABVO Approved Resident: First Last
Email
If reimbursing your employer or a company, please list name:
Are you located in the United States of America?

Are you located in the United States of America? Yes No
Name to cut check to: Name to cut check to: First Last
Address to mail check: Address to mail check:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
International Reimbursements:

International reimbursements need to be reimbursed via Wire Transfer, please include banking information below to process the wire transfer.

No checks will be cut for international reimbursements. Should you have any questions, please contact the ACVO office (ofice@acvo.org).
Name for wire transfer: Name for wire transfer: First Last
Personal address for wire transfer: Personal address for wire transfer:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Bank Name:
Bank address for wire transfer: Bank address for wire transfer:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Bank SWIFT or BIC:
Bank Account Number:
International Payment System Routing Code (only certain countries. Your bank will provide it if needed):
ACVO/ABVO COMMITTEE & BOARD REIMBURSEMENT, SELECT ONE OF THE FOLLOWING OPTIONS, IF APPLIES:
I am submitting for reimbursement as a committee member:
I am submitting for reimbursement as board member:
If you answered yes to either question above, please list the name of the committee or board:
If you are submitting reimbursement as a conference speaker, please list the name of the speaking engagement and date:
ABVO APPROVED RESIDENT COURSE REIMBURSEMENT REQUEST

*Note that reimbursements are allowed up to $500 for current residents, one time during the course of their residency program. The resident’s supervising Diplomate MUST be an active member of the ACVO as this reimbursement is a benefit of membership. The course being submitted for must have already been completed/attended.
I am submitting for reimbursement of expenses directly related to my attendance/registration fee at the:

I am submitting for reimbursement of expenses directly related to my attendance/registration fee at the: No Basic Science Course Vision for Animals Phaco Course
Enter date of meeting attended (must have already taken place and attended): Enter date of meeting attended (must have already taken place and attended): / MM / DD YYYY
Enter total amount requested for reimbursement (not to exceed $500, one time during residency):
Enter name of the Active ACVO Member that serves as a current ABVO-Approved Supervising Diplomate:
Email of ACVO Member/Mentor:
UPLOAD FORMS

Please complete and attach a summary form of expenses, along with a digital copy of the receipts.
Attach summary remibursement spreadsheet:

Attach Files
Receipts best submitted scanned into one document to reduce the number of attachments. (Limit five files.)
Attach pdf or Word copy of receipts:

Attach Files
Select the submit button below.

Reimbursements will be processed within two weeks. You will receive a copy of this form in your inbox. Contact the ACVO with any questions.

ABVO/ACVO Reimbursement Request Form

ABVO/ACVO Reimbursement Request Form

International Reimbursements:

ACVO/ABVO COMMITTEE & BOARD REIMBURSEMENT, SELECT ONE OF THE FOLLOWING OPTIONS, IF APPLIES:

ABVO APPROVED RESIDENT COURSE REIMBURSEMENT REQUEST

UPLOAD FORMS

Select the submit button below.