MVS Expense Report Form

MVS Expense Report Form
Request for Reimbursement

Please read the below guidelines before submitting your request.
Professional Development or Conference Expenses

Any fee over $35 must receive prior approval before submitting a request for reimbursement. Please include documentation of completion or attendance of event with your receipt.

Materials or Supplies

Any material or supply purchases must receive prior approval through the Classroom Materials Request form before submitting a request for reimbursement.
Employee Name

First NameLast Name
Employee Email Address
example@example.com
Entity Paid
Name of company / organization paid
Date & Time of the Expense

MonthDayYear
Date
Hour MinutesAM/PM Option
Expense Total
Credit CardCashCheck
Professional Development: Qualifies as Northern Lights PD HoursProfessional Development: Does NOT Qualify as Northern Lights PD HoursConferenceClassroom Materials or SuppliesFacility RelatedField trip / transportation relatedFingerprinting FeeOther - please describe in space provided below
Description of purchase(s):
Please provide details about the training, workshop, conference, material, etc.
Additional Notes:
Please upload receipt(s) and related PD/Attendance documentation

Cancelof
Signature

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Please verify that you are human*
Should be Empty:

Request for Reimbursement