Reimbursement Request
All requests must be received within 3 school days of the 10th and 25th of each month.
Email address *
Name *
Your answer
Phone Number
Your answer
Amount to be Reimbursed *
Your answer
Pre-Approval Number
If the expense was pre-approved, please enter the pre-approval number that you received via email.
Your answer
Date purchase was made *
MM
/
DD
/
YYYY
Purpose of purchase *
Your answer
Budget item to be charged *
How do you want to receive your reimbursement? *
Address (if requesting reimbursement by mail)
Your answer
Copy of my receipt is ... *
Please attach receipts to a printed copy of this reimbursement request, when mailing or placing in the Booster box.
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