Mileage Reimbursement Form

- The reimbursement rate is fourteen cents ($0.14) per mile.
- Cutoff for correctly-completed reimbursement requests is Tuesday at noon.
- Checks are cut on Wednesday and mailed no later than Friday.
- Prefer to fill out a printed form? Download Mileage Reimbursement Form (PDF)

Your name(Required)

First Last

Your email address(Required)

Delegation code

If you're associated with a Special Olympics Minnesota delegation, please enter code here.

Who should the check be made out to?(Required)

Mailing address(Required)

Street address City State ZIP code

Expense breakdown

Total mileage reimbursement amount

Notes/comments (optional)