LEAS Claims Form

Please complete this form if you are a Lived Experience Advocate who has completed a role and is now claiming your pre-approved honorarium.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Role ID(Required)

Please use the Role ID supplied in your role agreement from the LEAS Coordinator.

Role details(Required)

Please confirm the details of the role you have completed. Use the plus (+) symbol to add additional rows if needed.

Description

Number of hours

Date

Were all the above activities approved by the LEAS Coordinator?(Required)

For more information, please refer to the LEA Role Sheet, LEAS policies and procedures, or contact the LEAS Coordinator.

Yes

Claims can only be made if approved by the LEAS in advance. Please contact the LEAS Coordinator to discuss further.

Hidden

Did you incur expenses that were approved by the LEAS Coordinator?(Required)

The LEAS will only reimburse expenses specified in the LEA Role Sheet or agreed with the LEAS Coordinator in advance. For more information on approved expenses, please refer to the LEA Role Sheet, LEAS policies and procedures, or contact the LEAS Coordinator.

Yes

Expenses(Required)

Please list each expense you are submitting for reimbursement. Use the plus (+) symbol to add additional rows if needed.

Description

Amount

Date

Upload valid receipts(Required)

Please upload a valid receipt for each expense you are claiming. Refer to the LEAS Finance Policy for the requirements for valid receipts.

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 2 MB, Max. files: 5.

Are you able to receive payment by electronic funds transfer into a bank account?(Required)

Yes

Gift card payment reason(Required)

You can request payment of an honorarium (not expense reimbursement) by a gift card if you do not have a bank account, or if your current living circumstances prevent payment by electronic funds transfer. Gift card payments must be pre-arranged with the LEASC and a legitimate reason provided. The LEAS will not provide gift cards for an amount greater than $200 unless in exceptional circumstances.

Additional comments

Please add any additional information here

Signature(Required)

Your feedback is really important to help us refine and continuously improve the service, ensuring the best possible experience.

When you submit this claim form, you will automatically be redirected to the post-role survey on surveymonkey.com

Name

This field is for validation purposes and should be left unchanged.

LEAS Claims Form

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