Check Request Form
Request funds from the Clairemont Elementary PTA.
Yes, this reimbursement is for an approved grant request
No, this reimbursement for another approved purchase
Who should the check be made out to?
First and Last Name
Street Address, City, State, Zip
What is this for?
If item has already been purchased, attach receipt(s), in PDF or Image format to this form. Otherwise, provide receipt(s) as soon as possible after purchase to
. Approval must be obtained on all purchases. Failure to obtain approval may result in purchaser having to incur the expenses. Signature of the PTA president is required before treasurer will issue check.
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