IU12 Language Instruction Educational Program
Title III Reimbursement Request
Please complete the following form to submit for any Title III Eligible Reimbursement or Pre-Approval Requests.
District/ LEA Name
*
Please Select
Adams County Technical Institute
Bermudian Springs
Central York
Chambersburg Area
Crispus Attucks
Conewago Valley
Dallastown Area
Dover Area
Eastern York
Fairfield Area
Fannett-Metal
Franklin County Career & Technical Center
Gettysburg Area
Gettysburg Montessori Charter School
Greencastle-Antrim
Hanover Public
Juniata County School District
Lincoln Charter
Littlestown Area
Northeastern
Red Lion Area
School District of York City
South Eastern
South Western
Southern York
Spring Grove Area
Tuscarora
Upper Adams
Waynesboro Area
West York Area
York Area Regional Charter School
York County School of Technology
York Suburban
Other
Category/Purpose
*
Please Select
Family Engagement
Staff Reimbursement
Supplemental Resources Reimbursement
Professional Development/Conference
Who is purchasing this item?
*
Please Select
We will purchase
We have already purchased
We would like IU to purchase on our behalf
Unsure
Person Requesting Reimbursement
*
Email
*
example@example.com
Date of Request
*
/
Month
/
Day
Year
Date
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Family Engagement Reimbursement Request
Date of Family Engagement Event
*
/
Month
/
Day
Year
Date
Description of Items (Please add as many details as possible)
*
Total Cost
*
Link to all Receipts/ Flyer
*
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Title III Staff Reimbursement Request
Describe the Staff's role in supporting ELs directly.
*
Total Cost
*
Link to Timesheets
*
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Supplemental Resources Reimbursement Request
Description of Items (Please add as many details as possible)
*
Total Cost
*
Link to receipts, etc.
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Professional Development Reimbursement Request
Date of Professional Development Event
*
/
Month
/
Day
Year
Date
Total Cost
*
Description of Professional Development (Please add as many details as possible)
*
Link to Receipts/ Confirmation
*
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Thank you for your submission. We will review your request and be in touch shortly.
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