PTC Reimbursement Form

Today's Date

PTC Program

Person Making Request

Phone

MAKE CHECK PAYABLE TO

PHONE/TEXT #

ADDRESS (If check is to be mailed)

FOR THE FOLLOWING AMOUNT

DATE NEEDED

Event

List of Items Purchased

Expense Type

Amount

I UNDERSTAND ALL EXPENDITURES WILL BE ACCOUNTED FOR WITH SALES RECEIPTS, INVOICES, ETC., IN THE APPROVED BUDGET CATEGORY.

Authorization

Teacher/Requestor

Date

Event Coordinator/Teacher Approvals:

Director/Dept. Head

Date

Please attach receipts here

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