JA Reimbursement/Check Request

JA Reimbursement/Check Request

In order to receive reimbursement for any expenditures this form must be completed. If completed by the last day of the month, a check will be ready at the following month's general meeting (i.e. form completed by January 31, receive check at February general meeting).
Your Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Project/Event Name *
Purpose of Expense *
Amount Requested *
I would prefer *

Check to be picked up at the next monthly meeting Check to be mailed Pick up from Treasurer (Lacey 601-606-9492)
Make Check Payable To: *

Mailing address for check to be sent:

Any additional information needed for check (i.e, account #, name of client, memo)
Upload Photo of Receipt

Browse Files
Don't forget to click SUBMIT below. Cancel of
This reimbursement request is Project related. *

Yes No
If your reimbursement is project related please complete the information below.
Has your expense been cleared by your project chair?

Yes No (Please clear with your chair prior to submitting your reimbursement request. )
If your expense has been cleared, please enter the project chair/ JA member's name that cleared the expense.
Project/Event Date

Month Day Year
Date Date Picker Icon
Name of JA members that attended project/event
Brief description of the project/event
Approximate # of children/families served
Feedback or Comments for 1st VP/Self Eval/Project Finding
Should be Empty: