Free rent receipt 21
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Colorado Area Health Education Center
State Program Office
University of Colorado Anschutz Medical Campus

Official Rent Receipt
For AMC Health Profession Students on Rural Rotation
Date: ______________
This is to certify that I have received from _____________________________, Student’s Full
Name

In the amount of $__________ in payment for rent for ________ nights lodging.
First Night of Housing_____________ Last Night of Housing _______________.
(Students Note: You will only be reimbursed for one day of travel and actual rotation dates which
will be confirmed with the course coordinator. This receipt must be received in the AHEC Program
office within 45 days of the last date of your rotation. Reimbursement will not be paid to a student’s
parents or siblings).

_____________________________________
Landlord Signature
Note to landlords: Students are required to have this completed and signed receipt in order
to receive reimbursement for rental expenses during rural rotations. You shou