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Stipend Reimbursement Form 2025-2026
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Use TAB key to move between fieldsInvoice #
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IDENTIFY CO-SER:Select the corresponding coser
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District Requesting Payment:
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Name of ActivityShould match the name of the activity on the BOCES or district generated sign-in sheet (include sign-in sheet)
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Dates(s) & Hour(s) of Activity:Should match the date/time of the activity on the sign-in sheet
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Location:Should match the location of the activity on the sign-in sheet
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Corresponding BOCES Related Activity/Date (18 Month Limit)Complete ONLY for in-district PL that is a follow-up to a previous BOCES-facilitated PL (either regional or in-district) and include the approved in-district PL request form
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SIGN-IN SHEET(S) TO CONFIRM PROOF OF ATTENDANCE - MUST BE SUBMITTED WITH STIPEND REQUEST
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NAME# HOURS
FOR TEACHERS ONLY		 TOTAL DOLLARS
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Teacher Name1.00 $ 25.00
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TOTAL $ 25.00
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Superintendent Signature or *Authorized SignerDate
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*Authorized signers must be identified by district and formally on file with BT BOCES Business Office
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Please email completed form(s) to the Professional Learning and Innovation Center at:
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plicreg@btboces.org
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BT-BOCES (Office Use Only)
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Budget Code:
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Updated July 2025
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