YKLA - Reimbursement Request Form

Reimbursement Request Form
PLEASE READ BEFORE SUBMITTING
- Employees or volunteers, must seek pre-approval from their Department Heads, prior to making any purchases on behalf of the school.
- Employees or volunteers seeking reimbursement, must submit this form and upload all relevant receipts, prior to receiving reimbursment.
- Once submitted and approved, the request will be forwarded to Bookkeeping for reimbursement. Reimbursement checks will be issued on the 15th and last day of each month.
If you need additional information, need help completing this form or have questions about your reimbursement, please feel free to reach out to bookkeeper@ykla.org or 818-855-8379 x 101.
Employee/Volunteer Information
Name*

First NameLast Name
E-mail Address*
Your E-mail Address
Phone Number*
Please enter a valid phone number.
Purchase Information
Division*
Department*

Item Details*

Total Cost
Please describe what these items/services were for?*
Please include as much detail and information as possible, to assure this request is processed and reimbursed in a timely fashion.
Receipt(s)/Proof of Purchase
I have copies of the relevant receipts for this reimbursement, I would like to*

Upload them from my phone or computerTake a picture directly from this form
Please upload a copy of your receipt(s) below*

If you don't have an actual receipt available, please upload a copy of the charge, email or etc.
Cancelof
Take a photo of your receipt*
Pre-Approval Information
This purchase was pre-approved by?*
Approver Name*

First NameLast Name
Approver Email*
Email Address
Reimbursement Information
I would like to receive my reimbursement by*

CheckDirect Deposit
Do we have your direct deposit information on file?*

Yes, please use my direct deposit information on file, for my reimbursementI would like to enter or update my direct deposit information
Routing Number*
Account Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sign & Submit
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Reimbursement Request Form