
Reimbursement Form
Keys to Independence Reimbursement Request ( v1.2 )
Note: To expedite payment, we encourage our youth, caregivers and service providers to receive reimbursement via direct deposit. Click Here to apply for direct deposit.
Complete this form and upload all required documentation. All reimbursement requests must be accompanied by documentation indicating payment receipt and, when applicable, completion of the service (i.e., completion of a driver’s education course).
Reimbursement of an approved expense will be made within thirty days of receipt of the request. Program staff will contact the youth and his/her caregiver if any further documentation is required or if a reimbursement cannot be made.
If you are requesting reimbursement for insurance, please note the following eligibility requirements, per Florida statute:
- Youth completed behind the wheel lessons/driver’s education
- Youth holds an active driver’s license
- Youth is actively enrolled in K2I