PTO Reimbursement & Check Request Form

Instructions:

Consolidate submissions into one if possible.
Fill out form completely with budget/expense category, description of reimbursement or payment and breakdown of expenses (if applicable).
Attach up to 3 files/pictures/scans of all receipts and supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Please allow 1-2 week for processing. If a rush, make arrangements with the treasurer.
You will receive a receipt for your submission. If you don’t, it wasn’t completed.
Questions? Please e-mail our treasurer Brooke Pauley at bpauley62307@gmail.com

Name

First Name / Last Name

Email Address

email address

Should the check be mailed directly to the vendor/payee or dropped off at school?

Check made payable to:

Check Mailing Address:

Total Amount Requested for Reimbursement/Payment:

Committee/Event #1

Please indicate the Committee / Expense type on the form.

Committee/Event #2

Committee/Event #3

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Date Check Needed (please allow at least 1-2 weeks if possible):

Approved By:

Approval Date:

Date Check Issued:

Check Number:

Check Amount:

Notes: