Stipend Request If you are human, leave this field blank.Complete Request EntirelyFirst NameLast NameWhat Store Do You Work At?14th Street27th Street30th Street57th Street62nd Street96th Street88th StreetSpruce StreetRoast House111thPumaBryant Park36th StreetThe FactoryWhat Is Your Email Address?Type of Reimbursement *Fitness Reimbursement (classes, gym membership, citibike, intramural sports)Live Concert (broadway show, musical concert)Digital Memberships (hulu, netflix, disney+, spotify)Cell Phone Plan, Internet ReimbursementHeadspace ReimbursementHealth (Urgent Care, Acupuncture, PT, Insurance, Therapy)Educational Reimbursement (classes, museums)Amount of ReimbursementAny Questions or Comments?Upload Image of Receipt *Please note, only bills with your name on the account will be reimbursed. Upload Image of ReceiptUpload Image of ReceiptUpload Image of ReceiptSubmit
