Teacher Reimbursement

Instructions:

1. Fill out completely with description of reimbursement and breakdown (missing info will delay payment). Attach one file with copies of all receipts, preferably a PDF.
2. Specify if the check should be placed in your file folder or mailed to the vendor
3. A receipt of your submitted request will be emailed to you (keep for your records)

Reimbursement Information

Check Payable To:

Total Amount For Reimbursement:

Should check be placed in your folder or mailed?

If check is to be mailed, provide the address.

Expenses for Reimbursement

Expense 1 - Amount

Account to Be Charged

Expense Is For:

Place of Purchase

Attach Receipts

Please attach one file with copies of all receipts

Treasurer's Notes

(to be completed by the Treasurer)

Date Check Issued

Check Number:

Notes