NAMS Foundation Reimbursement Form

REQUEST FOR REIMBURSEMENT OR PAYMENT
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

Faculty / Administrator / StaffParent / Volunteer
This a request for:*

Reimbursement (I have already paid)Funding (I will pay the vendor)Purchase by NAMS Foundation (Tax-exempt)
Requester's Name*

First NameLast Name
Requester's Phone Number*
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?*

YesNo
Miles driven
Please send payment via:*

US MailSchool Office PickupDirect payment to vendor
Address to Remit Payment To:

Street Address

Street Address Line 2

CityState

Zip Code
Vendor address / website / e-mail contact:*
Is this request for technology (hardware, software, peripheral devices)?*

YesNo
Does the technology meet the criteria of the CPS District Approved Technology List or has it received approval on an Application for Technology Initiative (ATI) from CPS.*

Yes, on Approved Technology ListYes, ATI has been approvedNeither (must explain)
Description of use of funds and items purchased:*
Is the purchase consumable and/or reusable (check all that apply):*

ConsumableReusable
Event / Committee / Category use of funds were for:*
Example(s): Teacher Allocation, Field Day, Administration Expense, Father's Group
Upload copy of receipt:*

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

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REQUEST FOR REIMBURSEMENT OR PAYMENT