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Volunteer Extended Travel Stipend & Meal Reimbursement Request Form

Volunteers who travel an exceptional time for a volunteer shift may submit a request to help offset travel and expense. If the volunteer travel time exceeds 2 hours then volunteers may submit the following form to apply for a travel stipend. Travel stipends are calculated in 1/2 hour increments at $10/hour after the first hour of travel. A lunch reimbursement (up to $15) is available if the volunteer finds it necessary to purchase a meal during a long shift. A lunch receipt must be attached to this form to receive reimbursement.

By completing and signing the form below, I acknowledge:

  1. Volunteers are not employees of Donate Life Northwest.
  2. Stipends are intended to help defray travel and volunteer-related expenses.
  3. Volunteer shifts are scheduled on an as-needed basis and not guaranteed.
  4. Volunteer is expected to accurately account for their activities, and request a stipend within 60 days of the event.
  5. If a volunteer receives more than $500 a year in compensation, they will no longer be protected from liability claims by the Federal Volunteer Protection Act. (Volunteer Protection Act of 1997)
  6. The income from stipends is reportable to the IRS. Volunteers receiving more than $600 per year in stipends may be obligated to pay income tax.  Donate Life Northwest will file IRS Form 1099 for volunteers who meet this criteria.  Volunteers are responsible for filing IRS Form 1099 with their tax return. (Form 1099-MISC)
User Wrapper
Name as it should appear on the stipend/reimbursement check.
Last Name as it should appear on the stipend/reimbursement check.
Address where you would like the check to be mailed.
Volunteer Shift Info
Travel Time & Reimbursement Details
example: 1 hour there + 1 hour back home = 2 hours of total travel time
Lunch reimbursement cannot be processed without an attached receipt.
One file only.
60 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
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