Reimbursement Form
Name
*
First Name
Last Name
E-mail
*
Your E-mail Address
Phone Number
Program to be Charged
*
PTSA General
Live Events/Auction
Senior SPREE
PTSA Grant Awards
Equity & Inclusion
Teacher/Staff Appreciation
Other
Grant
Enter in the short description of your grant provided in your Next Steps email from the Treasurer. (image highlighted in yellow)
Expense List
*
Purchase Date
Description
Cost ($)
1
2
3
4
5
6
7
8
9
10
Total Cost
Receipt
*
Browse Files
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How would you like to receive your funds?
Mailed
Drop off at School Mailbox (Staff)
Pre-arranged pick up
Direct Invoice Payment (Check)
Electronic/ACH Transfer
Other
Write Check To:
Company/Person Direct Check Payment will be written out to
Address to Mail Check
*
Street Address
Street Address Line 2
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Zip Code
Notes
I certify that all information entered above is valid and true.
Submission ID
Amount
Treasurer Name
First Name
Last Name
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