College Student Fuel Reimbursement Form

Hi! We're so glad to have you at Riverbend, and we hope this gift will help make getting to and from our campus a little less stressful. We know how tight money can be as a young adult or college student so it is our privilege to help out just a little.

Be sure to read the details below and fill out this form completely. Our Office Manager Cassie will follow up with you ASAP.

Please know you have friends at Riverbend who are FOR you. There is always a place here for you to worship and serve.

**Be sure we have your correct email address (the one that you actually check) as that's how you'll be receiving your fuel card**

Your name *

Email address *

Phone number *

Address *

Birthday *

What school are you currently enrolled in and attending? *

How many times have you driven to/from Riverbend Church (or an event of Riverbend) this week? *

min: 1 / max: 20

Please list the dates and events that you drove to at Riverbend this week. *

How many miles do you drive (one way) to get to Riverbend from school? *

min: 1 / max: 100

Are there any others needs in your life right now? Anything we can help with? Any way that we can pray for you?

Please check if you have read, understand and agree too the terms and conditions below. *

TERMS, CONDITIONS, AND RULES FOR ELIGIBILITY:

1. Student must be currently enrolled and attending college classes.

2. Student must have been the driver of the vehicle that traveled to Riverbend. (passengers not eligible)

3. Student must have attended or served at the worship service or event they drove to.

4. Student must apply for fuel reimbursement every week that they drive to an event.

5. Student is eligible for $5 per trip to and from Riverbend, with a max payout of $50 per month, per student. (example: 10 trips to/from Riverbend = $50)

6. Payout will be in the form of a fuel card emailed to you.

7. Accounts will be assessed and fuel cards will be EMAILED bi-weekly, at the end of the 2nd and 4th week of each month. (example: If you drive here 3 times in 2 weeks, you will receive a $15 card at the end of the 2 week period)

8. Students may be required to prove enrollment before receiving a fuel card.

9. Riverbend Church holds the right to cancel this program at any time the leadership deems necessary. While we are committed to doing our very best to reimburse everyone who applies, Riverbend holds the sole right to decide who gets approved and who does not through this application process.

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