24-25 PTA Check Reimbursement Form

Instructions:

1. Fill out completely with description of reimbursement and attach all receipts.

2. A receipt of your submitted request will be emailed to you (keep for your records).

3. Receipts or invoice required for all reimbursements.

Reimbursement Information

Teacher & Room # (if applicable):

Check Payable To:

Phone/Email:

Please provide a phone number or email if there are questions regarding your reimbursement request.

Total Amount Requested for Reimbursement (inc. tax):

If a receipt is not attached, we are unable to reimburse the total amount requested.

Should check be placed in your folder or mailed?

If check is to be mailed, please provide the full address:

Expense 1 - $ Amount (inc. tax)

Account to Be Charged:

Expense Is For:

Attach Receipts

Please attach one file with copies of all receipts

Expense 2 - $ Amount (inc. tax)

Account to Be Charged:

Expense Is For:

Attach Receipts

Please attach one file with copies of all receipts

Expense 3- $ Amount (incl. tax)

Account to Be Charged:

Expense Is For:

Attach Receipts

Please attach one file with copies of all receipts

Expense 4- $ Amount (incl. tax)

Account to Be Charged:

Expense Is For:

Attach Receipts

Please attach one file with copies of all receipts

Notes:

All reimbursements must be approved by a person authorized to spend PTA funds. This request has been approved by the following person:

Approved By:

Other:

Email:

(to be completed by the Treasurer)

Date Check Issued:

Check Number:

Notes: