Expense Submission
Staff Name
*
Please Select
Esteban Rodriguez
Montcerrat Sanchez (Youth Dept. Staff)
Vanessa Melgoza (Health Dept. Staff)
Mason Garcera
Rowan Ewangan
Email
*
example@example.com
Date of Purchase (ON RECEIPT)
*
-
Month
-
Day
Year
Date
What type of request is this
*
Please Select
Purchase
Reimburtment
Cardholder this purchase was made through
*
Please Select
Esteban x4275 (nee x4091)
Mason x7052
Montcerrat x6256
Vanessa x1275
Other
Vendor
*
From who/where was the purchase made?
Short Description
*
Amount
*
e.g., 1.00
Account Number
*
Please Select
1-Fees for Service
2-Printing & Marketing
3-Office Expenses: Supplies
4-Food: Non Program
5-Food: Program
6-Telecommunication
7-Computer & Tech (IT)
8-Repairs & Maintenance
9-Travel
10-Staff Development: Food
11-Staff Development: Lodging
12-Staff Development: Transportation
13-Staff Development: Registration
14-Insurance
15-Fundraiser Expenses
16-Miscellaneous Expenses
17-Membership/Subscriptions
18-Bank Fees
Class
*
Please Select
Health
Youth
General
Funder
*
Please Select
ICJIA
IYIP
TPP
TR
RIG8
UNEF (Unrestricted)
GTZ
Hisp. Fed.
West40
Corporate
Individual
Unrestricted Indirects
Special Appropriations
Will be approved or denied depending on Grantor.
Receipt/Invoice Upload or Take a Photo
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Staff's Signature
*
Filled Fields - Submission for review is the final field.
Email for Approval or Declination (Auto-Populated to billing)
Submit for Review by Operations Department
Should be Empty: