Reimbursement Form

Approved Guaranteed Ride Home (GRH) participants for FY 21 (July 1, 2020 - June 30, 2021) must complete this form within 30 days of taking their Guaranteed Ride Home in order to receive a reimbursement.

Requestor Information

* required fields

*First Name:

*Last Name:

*Phone:

*Email Address:

*Employer Name:

*Employer Address:

*Employer City:

*Employer State:

*Employer ZIP Code:

*Destination Address (Must be home or location of parked car):

*Destination City:

*Destination State:

*Destination ZIP Code:

*Reason for Ride:

If Other, Explain:

*Mode of Transportation:

*Ride Costs
(Gratuity Cannot be Included):

*Estimated Trip Distance (Miles):

*Date of Ride:

*Time of Ride:

Additional information about your reimbursement request [optional]:

Mailing address same as destination address.

*Mailing Address:

*Mailing City:

*Mailing State:

*Mailing ZIP Code:

*Upload your receipt

commuter spotlight

Guaranteed Ride Home

“The Guaranteed Ride Home program was a lifesaver for me during a personal illness that occurred at work. I got suddenly ill during my shift but rode in on a vanpool of 6 people and couldn’t interrupt everyone else’s busy work schedule to accommodate me. Having the Guaranteed Ride Home program allowed me to have a safety net when I needed to get home ASAP! Within minutes I had a driver pick me up and get me home safely and quickly without having to disrupt the work of my fellow vanpool commuters.”

-vanpool participant

Quick Links

GRH Home

Program Guidelines and Agreement
(English/Spanish)

Frequently Asked Questions (FAQs)