NOTE: This reimbursement scheme is currently offered only for placements in 2017.

The School of Nursing & Midwifery will reimburse the equivalent of a return bus fare for all students attending clinical placement at a rural venue in South Australia as part of the School’s Rural Clinical Program (up to a maximum of $500.00). Where other forms of transport are cheaper, reimbursement will be the equivalent of the cheaper fare.

For placement purposes, a rural venue is considered to be a venue 100km or further from the Adelaide Central Business District (CBD) for students enrolled in the nursing program at the Flinders campus in the Adelaide metropolitan area, and 100km or further from the Renmark campus for students enrolled in the Riverland nursing program.

Reimbursement can be claimed only for travel to and from the clinical venue at the beginning and end of placement. Should a student choose to travel to the rural venue and return to their residential address for each placement shift, only travel to and from the venue, at the beginning and end of placement, will be reimbursed.

Claims should be submitted within one month of the end of a placement.

Documentation required:

□ Tax invoice/s* for travel expenses
(*requires the words ’tax invoice’, the supplier’s ABN, and the GST if applicable)

□ Attached form (page over), with sections 1, 3 and 4 completed

Please submit form and supporting documentation, to the School of Nursing & Midwifery Office by person or by email to

You will be notified by email when payment has been deposited into a bank account.

Complete this form in Word and submit this form + supporting documentation to the SONM office, or by email to . Payments are usually processed within 3 weeks.

  1. STUDENT DETAILS

Name: / Student number:
Email: / Phone:
Street Address:
College: / Nursing and Health Sciences / School: / Nursing & Midwifery
  1. CLAIM DETAILS

Project codes can be obtained from your supervisor (or the staff member who authorised the expense).

Reason for expense:
Expense type and description*
(Group similar items into one row) / Receipt Amount
AUD** / Project name / Project
code
Travel to and from the clinical venue at the beginning and end of placement / SONM Professional Experience Placement / 01.601.00072.2314
Total

*To calculate mileage, use the ATO guidelines and attach copy of log book as evidence.
**To convert foreign currency, use conversion rates on the date of purchase.

  1. FINANCIAL INSTITUTION DETAILS

Australian accounts only (for payment to an international bank account, attach an International Bank Account Details form)
Institution Name: / Name of Account Holder:
Account Number: / BSB:
  1. DECLARATION

I certify that the above expenditure details are correct and I have attached scanned supporting documentation. This is the only claim I have made, or will make for these expenses.
Student signature: / Date:
  1. ENDORSEMENT BY (SONM PEP)STAFF MEMBER

These expenses were incurred for University business purposes and comply with applicable grant conditions.
I have checked the supporting documentation.

Staff member:
Signature: / Date:

PEP office use only

Venue and dates: ______