Riverside County Fingerprint Reimbursement

Complete this survey to be reimbursed for the cost of fingerprinting. Fingerprinting must be completed within 45 days of completing 4-H Online enrollment and the mandatory adult volunteer training.

You must upload your receipt and completely answer all questions.

✻ = Required

Full Name (The reimbursement check will be made payable to this name.) ✻

Email address ✻

Phone Number ✻

Address: The reimbursement check will be mailed to this address. Enter the full address with house number, street, city, state, and zip code. *Your check request cannot be processed without the full address.*

Street Address (house number and street) ✻

City ✻

State ✻

Zip Code ✻

Vendor Information: You must enter the name of the business or entity that did your fingerprinting and the amount it cost.

Vendor (Name of business where fingerprints were taken.) ✻

Amount (Cost that was charged by the vendor to complete the fingerprinting. Riverside County 4-H will reimburse up to $30.) ✻

Enter the ATI number you received when you completed the fingerprinting. It will be on the bottom of the Live Scan form copy you received from the vendor. (Keep this form for your records!) ✻

You must upload the receipt from the business or entity that completed your fingerprints that show the cost you paid. *You must upload this receipt in order to be reimbursed!*

Upload your file