NAMS Foundation Reimbursement Form

Please attach receipts and any other relevant documentation, if seeking reimbursement. If seeking funding in advance or a purchase by Foundation directly (tax-exempt), explain the request thoroughly and attach or link to all relevant documentation (orders, invoices, catalog information, etc.). Any questions, please contact a representative of NAMS Foundation.

I am a NAMS

This a request for:

Requester's Name

First NameLast Name

Requester's Phone Number

Format: 000-000-0000.

Requester's Email

example@example.com

Make Check Payable To:

Total amount requested for reimbursement / payment:

Must match value of receipt / invoice / documentation or explain variance below

Mileage reimbursement: Did/will you drive at least 10 miles in a personal vehicle for this task? (Do not include commuting between your home and NAMS)

Miles driven

Please send payment via:

Address to Remit Payment To:

Street Address

Street Address Line 2

CityState

Zip Code

Vendor address / website / e-mail contact:

Is this a request for technology (hardware, software, peripheral devices)?

Is the technology currently on the CPS District Approved Technology List or has it received approval on an Application for Technology Initiative (ATI) from CPS?

Software Approved List
Hardware Approved List
Application for Technology Initiative (ATI) Form (requires CPS login)

Description of use of funds and items purchased:

Is the purchase consumable and/or reusable (check all that apply):

[Obsolete field -- keep for historical data. -IR Nov 2025] Event / Committee / Category funding is from:

Examples: Teacher Allocation, Field Day, Administration Expense, Father's Group, PTO

Event / Committee / Category funding is from:

Indicate the source of funds requested

Source of funds: Other (specify)

Upload copy of receipt and any other information relevant to your request:

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Upload invoice, quote, price list, or other information relevant to your request:

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Math Challenge (verify you are human)

REQUEST FOR REIMBURSEMENT OR PAYMENT