Education Reimbursement Form
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Box 785040 Orlando, FL 32878-5040 Fax: 1-888-211-9900 Education Information Employee Certification (Required) Education Reimbursement Form Yale University (05102) Employee Certification (Continued) By adding my signature on the first page, I certify that the information I’m providing is correct and the expenses for which I’m requesting reimbursement, or for which I’m validating: Were incurred for services or supplies received by my eligible dependents or me under the plan Were for services or supplies furnished on or after the date my spending account takes effect Haven’t been reimbursed in any other way or from any other source and won’t be submitted for future reimbursement and Don’t include any amounts that are otherwise payable by plans for which my dependents or I are eligible..
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