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Negotiations
Resources
Contracts
SHC
LPHC
PNDP
SHC
LPHC
FAQ
Group D Retirement
Nurse Practical/Legal
Forms
Submit an ADO Here
CRONA Scholarship Application
Consent to Serve form 2022-2025 term
Nurse Advocate Request
Other forms
Contact
Request a Nurse Advocate
Contact
Form testing
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Name
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Email
(Required)
Phone
Type of phone line
Land line
Mobile phone
Address
(Required)
Street Address
City
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District of Columbia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
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Please enter your complete mailing address.
Hospital (check one):
SHC
LPCH
Unit name
Type of expense
Food (webinar expense only)
Supplies (specify)
Other (specify)
Description of expense
Date expense incurred
MM slash DD slash YYYY
(Maximum reimbursement is $75 monthly)
Type of expense
Food (webinar expense only)
Supplies (specify)
Other (specify)
Description of expense
Date expense incurred
MM slash DD slash YYYY
(Maximum reimbursement is $75 monthly)
Mileage (include map showing route)
I have mileage to claim
Please see IRS guidelines regarding reimbursement for work-related mileage. CRONA reimburses mileage at the current IRS rate. If claiming mileage, you must include (as an attachment) a map from Google Maps, Mapquest, or similar, showing mileage.
Number of miles
Please enter a number from
0
to
1000
.
Reason for mileage
Date expense incurred
MM slash DD slash YYYY
(Maximum total reimbursement is $75 monthly)
Upload receipts
Drop files here or
Select files
Max. file size: 256 MB.
Signature
(Required)
I certify that all expenses were incurred in the fulfillment of my role as a CRONA Area Representative. I understand that I may not be reimbursed for purchases that are for my personal use, with the exception of purchasing food to be consumed by me on the evening of the monthly Area Representative/membership webinar. All expenses are subject to review by the CRONA Treasurer.
(Required)
I agree to terms and conditions
(Required)
I certify that all expenses were incurred in the fulfillment of my role as a CRONA Area Representative. I understand that I may not be reimbursed for purchases that are for my personal use, with the exception of purchasing food to be consumed by me on the evening of the monthly Area Representative/membership webinar. All expenses are subject to review by the CRONA Treasurer.
Email
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