Argus II Building
400 South Fourth Street
Ann Arbor, MI 48103-4816

Phone: (734) 615-0643
Toll-free: (877) 869-5266
Fax: (734) 936-1913
E-mail: Work.Connections@umich.edu
Website: workconnections.umich.edu
University of Michigan Work Connections Illness and Injury Assistance

Mileage Reimbursement Form

Treated By Treatment Date Mileage (Round Trip)