MSG Student Group Reimbursement and Purchase Order Request Form

If you haven’t yet viewed the Student Organization Funding page, please do so before filling out this form. You will most likely need to fill out a Statement of Business Connection form which can be found on that page.

All fields are required unless otherwise noted.
Note that you must first select which type of request this is. See below for instructions and descriptions.
  • MSG Reimbursement Request: Use this form if you chose not to use a Penn approved vendor. It will take 4-6 weeks for you to receive a reimbursement check. For reimbursements greater than $25, you must submit an itemized receipt and list of people who attended the event using the online Concur system.
    • The majority of MSG reimbursements need to be processed through the online system, Concur.  Once your reimbursement request has been approved by the MSG Treasurer, please email Nancy O’Reilly, noreilly@mail.med.upenn.edu, the following information for you to be activated in the system:
      • Your full name
      • Your Penn ID number
      • Your current local address
    • Activation takes approximately 5 days.  Once this time period passes, please contact Nancy O’Reilly for further assistance.
    • Petty cash, which is $25 or less, will continue to be processed through hard copies.  Once your petty cash reimbursement request is approved, please bring all original receipts, including the itemized receipt; and, where appropriate – the receipt indicating a tip, to Nancy O’Reilly in Suite 100 for processing.
  • MSG Purchase Order Request: Use this if you are requesting goods/services from a Penn approved vendor. So that the purchase order may be processed in time, this form must be submitted a minimum of 4 business days before the event. The PO process is as follows:
    1. The student calls the vendor, gives them the order and requests a quote, letting the vendor know it will be paid through a purchase order.
    2. The students puts in the PO request via this form using the dollar amount the vendor gave them. Once submitted the student will also receive a confirmation by e-mail.
    3. Once the PO is approved, Nancy O’Reilly will create a PO requisition online and email the student the PO number that is generated in the system.
    4. The PO is automatically faxed by Penn’s Purchasing department to the vendor.
    5. The vender automatically sends the invoice to Penn’s Accounts Payable department for payment.
  • Office of Student Affairs House Purchase Order Request: Use this form if you are submitting a request for a House event. The PO request goes through the same process as for Student Groups.

Request Type

Your Full Name

School of Medicine Email

Phone Number

Address

Your PennCard Number

Last 4 Digits of Your SSN

Student Group Name (or House Name)

Expense Information

This request is for
 food, no alcohol (5211) office supplies (522x) entertainment (5214) other

Total amount (including tips but not taxes).
$

List of items purchased with money. If you are splitting this cost with another group, please indicate so here.

For Purchase Orders Only

Vendor Name (if Penn-approved)

Vendor Phone Number

Event Information

Enter N/A for each if this is not an event

Name of Event

Date of Event (MM/DD/YYYY)

Time of Event

Location

Event Description (including expected attendance, name of speaker, topic of talk, etc.)

 Did you submit your event to thecalendar?

Post-Event Information (Optional)

(This info will be requested in future email if this request is for a PO.)

Number of Attendees

Advice for future organization leaders:
Do you feel this event was successful? Should a similar event be hosted in the future? Are there any changes you would make?

Please remember to submit your receipts to Nancy O'Reilly to have your reimbursements processed