2017-18 DAIS PTO Disbursement Requests
Please complete this form when requesting monetary reimbursement from the DAIS PTO. A copy of the receipt must be provided to the PTO for reimbursement. You may provide a copy of the receipt to your community office (attn: DAIS PTO) or email the receipt to
Name of person requesting reimbursement
Amount being requested for reimbursement
Reason for reimbursement
Student Information (Name, Team, Homeroom)
How would you like your reimbursement:
Mailed (*If you select this option, please complete the question below.)
Sent home with student
Mailing address for reimbursement
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