Request for Supplemental Funds
To be approved prior to purchasing items.
Requested by:
First Name
Last Name
Request Date
-
Month
-
Day
Year
Date
Email
example@example.com
Site
*
Please Select
AEC
ESM
GFH
LLC
MLKCC
NCDC
NECC
SCC
SFCC
SHCB
WBC
WCCC
Room#
Budget - please select one or more
*
Head Start
Early Head Start
Purpose of Purchase:
*
Please Select
Health
Safety
Licensing
Early Achievers
Accreditation
Program Requirements
Other - Include in description below
Brief description of need/purpose
*
Component:
Please Select
Administrative
Education
Health
Information Technology
Mental Health/Disabilities
Nutrition
Parent Engagement
For consistency across the program, has the Center Manager, Classroom Quality Coach, and Component Specialist coordinated this request?
*
Yes
No
N/A
Brief description of items including cost per item and quantity
0/150
Amount Requested including Tax/Shipping and Handling
*
Vendor Name/Website
Note: If this request is to purchase from Community Playthings, once approved, fiscal staff at Esmeralda must place the order.
Printed List/Shopping Cart
Browse Files
Drag and drop files here
Choose a file
Screenshots accepted
Cancel
of
Date Funds Needed
-
Month
-
Day
Year
Date
Supervisor's Name
Please Select
Bobbi Woodral
Deanne Wilson
Lee Ann VanLengen
Lisa Hollen
If this purchase request is for a center-based education supply purchase, please select Deanne Wilson as the supervisor. If this is for a non-education center-based purchase, select Kim Pratt.
Supervisor's email
Please Select
bobbi.woodral@ccs.spokane.edu
deanne.wilson@ccs.spokane.edu
leeann.vanlengen@ccs.spokane.edu
lisa.hollen@ccs.spokane.edu
Supervisor's Email from dropdown
example@example.com
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Should be Empty: