HomeMy WebLinkAboutReimbursement Form for Schools FY 1415INSTRUCTIONS:
1. Itemize and attach all receipts and backup with a
copy of the cancelled check to this form in the
same order listed below.
2. Cancelled check issued by your organization must
be attached to qualify for reimbursement.
3. Both Representative AND Principal must sign and
date form and submit no later than June 30, 2015.
Funding Year:
2014-2015
REIMBURSEMENT
FORM
(For School Organization Reimbursement for
Outside Agency Funding)
4.
Only expenses listed on your original application
and shown on Schedule A of your agreement can
be included for reimbursement.
Submit to: City of Palm Desert - Finance Dept.
Attention: Niamh Ortega
73-510 Fred Waring Drive SCHOOL
Palm Desert, CA 92260
Phone: (760) 346-0611, Ext. 382
Fax: (760) 341-4564 Contact Name
Contact Phone No.
FORM MUST BE SUBMITTED BY JUNE 30, 2015 Amount awarded
by Council
Date of
Receipt
Name of Vendor
Expense Paid To Description of Expense Amount
Less 50%
matching
funds
Reimburse
-ment
Requested
1
Ex: 5/31/15 ABC Transportation
Bus transportation for school trip from school to Living
Desert on April 6, 2015 3,000.00 (1,500.00) 1,500.00
2
3
4
5
6
7
8
9
10
TOTALS
Total Reimbursement Request: ___________
Signature of Authorized Representative Date
Principal Signature
Date