University Student Affairs – California » Gym Membership Reimbursement Form

AT THIS TIME: Only Accepting Month-to-Month Requests

If you pay annually for your membership, the deadline for the 2023-2024 AY was September 1, 2023.

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AT THIS TIME: Only Accepting Annual Pre-Paid Requests

If you pay monthly for your membership please wait until you've paid for 10 CONSECUTIVE MONTHS and then submit your request. Deadline for the 2023-2024 AY is June 1, 2024.

WesternU may reimburse you up to $100 for your fitness membership. Only current students are eligible for this benefit

YOU WILL NOT BE ELIGIBLE FOR REIMBURSEMENT IF YOU HAVE A MEMBERSHIP TO SAMFIT. By purchasing a SamFit membership through WesternU, the membership is already subsidized by $100.

We process hundreds of reimbursement request. To help ensure you have the required documents, please answer the questions below:

This request is for academic year (July-June)*

2023-2024
No

Do you have proof the membership is in your name?*

If you do not have proof the membership is in your name, please contact your gym or login and find a contract/document showing your name and the gym.

Yes
No

Do you have proof of membership dates AND payment for 10-months of the current academic year?*

July to June. If you do not have proof, please contact your gym or login and find a contract/document/payment history showing your membership start/end dates and payment(s). If you pay annually, we need proof of your one payment plus membership start/end dates. If you pay monthly, we need proof of all 10 months of payment/membership. In either case, the proof of payment must also include your name.

Yes
No

Have you merged all of your documents into one .pdf?*

Multiple-page upload is not allowed on the next screen so please merge everything into one .pdf.

Yes
No

If you answered "no" to any of the above questions. You will not be able to proceed to the next page. Please gather the necessary documents and then submit.

Your Information

Name*

First Last

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Student ID Number*

Program*

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Activity

Year of Graduation*

WesternU E-mail Address*

MUST BE WesternU E-MAIL - DO NOT ENTER A PERSONAL E-MAIL ADDRESS HERE.

Please enter your WesternU email address. Entering your personal email address will not allow you to continue form submission.

Who is your membership with?*

As a reminder, we Do Not reimburse for SamFit memberships as we are contracted with them and students who join through WesternU receive a subsidized memberships.

Enter amount to be reimbursed.*

For example, if your renewal fee was $99, enter $99 below. If you paid $350 total for your one year memberships then enter $100 below.

Please enter a number from 1 to 100.

All payments are processed via direct deposit unless you are not set up with the Bursar's Office.*

I am set up for direct deposit
I am not set up for direct depost and would like a check

How do you pay for your membership?

Monthly
Annually

Regardless of how you pay you must have proof of:
1) Payment during the current academic year.
2) Membership dates.
3) That the membership is in your name.

Proof of Membership/Payment

What date did your membership begin:*

What date is your current membership ending:*

Upload Proof:*

PLEASE MERGE YOUR DOCUMENTS INTO ONE PDF BEFORE UPLOADING

1) Of membership dates.
Must have proof of membership for a minimum of 10 months within the current academic year: July-June
2) Of payment
Must show that the membership is paid in full (for annual) or proof of payment for ALL 10 months (if month-to-month).
If providing your credit card statement you must block out personal information and purchases not needed for this request.
3) That the membership is in your name
This is a benefit for current students only

Send questions to studentaffairs@westernu.edu

Drop files here or

Accepted file types: pdf, Max. file size: 125 MB, Max. files: 1.

Please do not submit 10-months of your full credit card statements as it's too cumbersome and shares personal data that we don't need. The best option is to get a billing statement from your gym(s). If credit card statements are your only option, then black out all other purchase and the account number.

The submit button is hidden because you indicated you pay Annually for your membership. At this time, we are only accepting month-to-month requests. The deadline for annual/prepaid was September 2023.