Community Impact Story Reimbursement Form

Funds are available to reimburse costs associated with the development and sharing of the community impact stories from your grant project. Please complete this form to request reimbursement.

Name(Required)

First Last

Credit Union(Required)

Organization

Email(Required)

Phone

Grant Project Name(Required)

Reimbursement Amount Requested(Required)

Please describe how funds were utilized to share the community impact story related to your grant project.(Required)

Upload Collateral(Required)

Please upload any relevant collateral (ie. marketing videos, images, etc) developed with these funds.

Drop files here or

Max. file size: 100 MB.

Upload Receipts(Required)

Please upload receipts relevant to this reimbursement request.

Drop files here or

Max. file size: 100 MB.

Consent(Required)

I give NWCUF permission to redistribute uploaded videos, images, and other media files on various online channels and have the authority to grant such permission. NWCUF reserves the right to edit submitted content.