Reimbursement Form 2018

Please direct any questions about the reimbursement process to intern@masstech.org.

Submission Deadline: October 31, 2018

Company Information

Student Intern Information

Intern #1
Intern #2
Intern #3

Stipend Reimbursement Calculator

Please enter your student intern pay data in the following fields. Hours worked should not include any paid holiday or vacation time.

Proof of Payment

  • Proof of payment must verify:
    • Intern name
    • Company name
    • Hourly wage or total hours worked
    • Gross pay
    • Pay period dates (check dates are not sufficient)
    • Payroll tax deductions
  • Acceptable proof of payment:
    • Payroll reports, registers, or journals
    • Paycheck stubs
    • Earnings statements
  • Unacceptable proof of payment:
    • Canceled checks
    • Any documentation that does not show required tax deductions
    • Excel spreadsheets
  • Payroll reports generated by third-party vendors are preferred.  

Do not send any documents that include Social Security Numbers.

Please certify the following: