Cash For Wellness Form
Please ensure that you've completed the form entirely and uploaded all documents required for your claim. Should you have questions about the process, reach out to any of the executive for support.
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Contact Information
Name
*
First Name
Last Name
Teaching Status
*
Please Select
Permanent
Probationary
Term
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Site
*
Please Select
Advocate District School
Amherst Regional High School
Chignecto Family Office
Cumberland North Academy
Cyrus Eaton Elementary School
E. B. Chandler Jr. High School
Northport Consolidated Elementary School
Oxford Regional Education Centre
Parrsboro Regional Elementary School
Parrsboro Regional High School
Pugwash District High School
River Hebert District School
Spring Street Academy
Springhill Elementary School
Springhill Jr./Sr. High School
Wallace Consolidated Elementary School
West Highlands Elementary School
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Details of Claim
Brief description of purchase and explanation of how it will support your personal wellness goals:
*
Receipt(s)
*
Browse Files
Drag and drop files here
Choose a file
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of
Total Cost
*
Maximum reimbursement is $100
Signature
*
Date of Claim
*
-
Year
-
Month
Day
Date
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Should be Empty: