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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:School Curriculum Improvement
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District Requesting Payment:
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Name of Activity
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Dates(s) & Hour(s) of Activity:
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Location:
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Corresponding BOCES
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Related Activity/Date (18 Month Limit)
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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		 Hourly Rate TOTAL DOLLARS
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 $ 25.00 $ -
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TOTAL $ -
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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 September 2025
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