Expense Reimbursement Form

Expense Reimbursement Form
INSTRUCTIONS
1. Please note that only pre-approved order requests can be claimed via this form. The order must be pre-approved by the school business administrator and the school director.
2. If you require items to be purchased for your classroom, please use the purchase requisition form via iLearn Schools Portal.
3. Please list the supplies and/or materials you purchased below and attach the applicable receipt and/or proof of purchase to this form. Please provide a general description of your purchases (e.g. pencils, computer software, CD-ROMs, books).
4. We will not reimburse sales tax. Purchases should be made using the appropriate School Tax Exempt Form.
5. Images taken thru cell phone devices, tablets are not accepted. Please scan your receipts via a copy machine and send your original receipts to the central office.
6. Please review your school's board meeting dates at your campus' respective site under Board of Trustees tab.
Section I
Employee Name*

First NameLast Name
Employee Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Request*

MonthDayYear
Date
Location*
Section II - Items for Reminbursement
Purpose/Explanation*
Is this pre-approved by the Business Office?*
Pre-Approval is required for reimbursement. Unfortunately, this purchase can't be reimbursed.
Item One
Item-1 Date*

MonthDayYear
Date
Item-1 Cost*
Item-1 Description*
Item Two
Item-2 Date

MonthDayYear
Date
Item-2 Cost
Item-2 Description
Item Three
Item-3 Date

MonthDayYear
Date
Item-3 Cost
Item-3 Description
Item Four
Item-4 Date

MonthDayYear
Date
Item-4 Cost
Item-4 Description
Item Five
Item-5 Date

MonthDayYear
Date
Item-5 Cost
Item-5 Description
Total Cost of All Items
Upload Receipts *

Cancelof
Signature*
Email*
example@example.com
Signed On

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

Expense Reimbursement Form

Section I

Section II - Items for Reminbursement

Item One

Item Two

Item Three

Item Four

Item Five