Health Professionals Student Association (HPSA) Reimbursement Request Form

Note: All students seeking reimbursement must submit a copy of the University Non-Employee Information Form, found here, the first time they submit for reimbursement. Please download open that form, then save and complete it before uploading below. You will only do this the first time you submit for reimbursement.

Tax: Penn State College of Medicine cannot refund any state taxes charged during your purchase. If your reimbursement receipts have a tax amount listed, this will be deducted from your total refund amount. 

Amazon Purchases: Penn State University prohibits reimbursement of Amazon purchases using personal credit cards. If you request reimbursement for items you purchased on Amazon, your request will be denied.