Reimbursement/Check Request

This form is to be used by volunteers, teachers, staff and administration when requesting reimbursement for budgeted expenditures and approved funding requests.
Requester's Name*
First Last
Email*
Mobile Phone
Payee's Name:*
This is the name that will be printed on the check.
Payee Type*
Please select the type that most appropriately applies to the Payee.
Reimbursement Information
Title for this Request*
Reimbursement Amount*
Combine multiple receipts into one check payment amount.
Please enter a number greater than or equal to 0.5.
Description*
Please describe the purpose for the reimbursement and a summary of the items purchased. Do not list each line item on a receipt.
Upload Receipts
For simplicity, you may take a picture or scan a printed receipt and upload. For online purchases, save the receipt to PDF format and upload.
Drop files here or
<<< Office Use Only >>>
Approval #1:____________________________ Approval #2:____________________________ Date:________________ Exp Cat_______________________________ Chk#_______________
Approval Status
Payment Status
Check Number

This form is to be used by volunteers, teachers, staff and administration when requesting reimbursement for budgeted expenditures and approved funding requests.