PRT Reimbursement Request Form
Last Name
Your answer
First Name
Your answer
Email Address
Your answer
Mailing Address
Reimbursement check will be mailed to this address
Your answer
Expense Date
MM
/
DD
/
YYYY
Expense Amount
Your answer
Expense Category
Description of Expense
Please provide a detailed description of the expense (i.e. Coffee from Starbucks for Staff Breakfast)
Your answer
What grade level is this expense for?
I would like to convert the expense to volunteer hours in lieu of reimbursement
Be sure to log your volunteer hours on scclc.net if selecting this option.
If you are completing this on behalf of someone else, please list name/contact info for the person who should receive reimbursement. You may also use this space to add any other comments.
Your answer
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