Please use the new
reimbursement request form
. Contact the
Odyssey PTA Treasurer
with any questions.
REIMBURSEMENT REQUEST FORM
Please fill this form out as completely as possible. All purchases made by a volunteer must be authorized by an Odyssey teacher or a PTA Board member in advance. Receipts are required for reimbursement. Please direct questions to Brian Winters, Odyssey PTA Treasurer, at ospc-finance@odysseyprogram.org.
Date of Reimbursement Request
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requestor Name
*
Check Payable To
*
Name of Individual/Company
Address (if check will be mailed)
Street Address
Street Address Line 2
City
State
Zip Code
Description of Expense(s)/Reason for Reimbursement
*
Reimbursement Amount Requested
*
Please enter a number without a dollar sign.
Expense Category
*
Classroom Expense
Field Study
Performance
PTA/School Support
Fundraiser Investment
Other
Cluster (if more than one cluster is selected, explain breakdown in "notes" field)
*
K12
345
678
All School
Other
Name of Odyssey staff or PTA board member who approved this purchase
*
Payment Delivery
*
Teacher Mailbox
Leave with School Secretary
Mail
Other
Take a Photo of Your Receipt (Usually for a Smartphone)
Upload a File with Your Receipt (Usually for a PC)
Upload a File
Cancel
of
For PTA Treasurer use only
Check #
Payment Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
MM Entry Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Should be Empty: