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Impact Type & Measurement

Requested Information

Type of Event

Please choose the category that you believe most describes your experience.

Mileage Reimbursement

Fill in All the fields below to qualify for the reimbursement if you drove your Private vehicle for CEL related purpose.

Indicate ONLY: Address, City, State, Zip Code
Select “Yes” if you were driving your personal vehicle to the destination. Do not use for CEL vehicles.
Select “Yes” if destination is greater than 5 miles from 700 West Olney Road, Norfolk. Can be calculated in Google Maps.
Provide the exact mileage from 700 W Olney Road to the destination with the most direct route based on Google maps.

About Your Experience

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Sharing and Privacy Settings

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