New Student Expense Evidence
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* required field
Received Date
Change Reason
[code-table-value]
Effective Date of Change
Student Expense Details
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Household Member
[field-value]
Student Expense Type
[code-table-value]
Amount
Frequency
[Daily]
Start Date
End Date
Reimbursed Type
[code-table-value]
Reimbursed Amount
Comments
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