PTA Reimbursement/Payment Request
Please fill out the form below to request reimbursement or payments from the PTA for classroom, school, or PTA related expenses.
Name
First Name
Last Name
Email Address
example@example.com
Date of Request
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I am submitting this request as a:
Rockwell Teacher/Staff Member
PTA Volunteer
Room Parent
Other
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Room Parent
Teacher/Class
Event/Activity
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PTA Volunteer
Please list the budget line item your purchase/reimbursement request is for. If you do not know the specific budget line, please give a brief description of the event/program that your request is for.
Budget Line Item/Description
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What are you requesting?
*
REIMBURSEMENT REQUEST: I've already paid for it myself and I have my receipt(s)
PAYMENT REQUEST: I have a copy of the invoice sent to me from vendor(s) and I'd like PTA to pay the invoice (Example: You have already set up a field trip experience and the vendor has sent you an invoice for payment)
PURCHASE REQUEST: I know exactly what I need and have links to everything and would like PTA to purchase it for me (Example: This is for item purchases directly from websites like TPT, etc. We will not make in-person purchases unless it is something that has been pre-arranged with the PTA Board)
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PURCHASE REQUEST
I know EXACTLY what I need and have links to everything and would like PTA to make the purchase for me.
When inputting information here, please be as descriptive as possible
*
Rows
Link to Requested Item
Item Number or Exact Name of Item(s) Requested
Item Cost
Item Details (Qty, Color, etc..)
1
2
3
4
Please take a screenshot of your item(s) EXACTLY as you'd like them ordered and upload it here. Can be individual items or a screenshot of your cart
*
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Estimated total cost of purchase request
*
Any additional information/details needed for this order? Please be as specific as possible so we can avoid ordering the wrong item for you.
Where would you like your item(s) delivered (if applicable)?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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PAYMENT REQUEST
I have a copy of the invoice from the vendor and I'd like PTA to pay the invoice.
Vendor
*
Brief description of the activity/item that you are requesting payment for:
*
Total purchase amount requested
*
Please upload a copy of the invoice from the vendor. Please make sure that all payment information is included on the invoice.
*
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REIMBURSEMENT REQUEST
You have already paid for this item, have your receipts, and would like to receive reimbursement from the PTA.
Please enter receipt information here for all items.
*
Rows
Purchase Date
Vendor
Item
Amount
Receipt #1
Receipt #2
Receipt #3
Receipt #4
Receipt #5
Total reimbursement amount requested (auto-populated from the fields above)
Please upload all receipts from the previous fields
*
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Please indicate how you'd like to receive your check.
US Mail
Office/Kid Mail
For Kid Mail:
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Treasurer/Funds Allocation Notes
Don't forget to select the Green "Submit Request" button below, Thank you!
You should receive your check within two weeks of submission. Please reach out to treasurer@normanrockwellpta.org if you have any questions.
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