* indicates a required answer.
List the Activity for this Reimbursement/ Refund: (i.e. Academic Co-op Period, Enrichment Day, Year End Picnic, etc.)
Method of Reimbursement: (NOTE: PayPal is faster and doesn't cost us postage or printing.)
My PayPal Email address is:
Income from Activity: (if applicable)
List Detail and Amount Collected
Total Income: $
Expenditures: (email- preferred or mail receipts)
List each Receipt and Amount:
Total Expenses: $
Refund Request: (request submitted by coordinator)
List canceled class or event.
Total Refund $:
Please make check Payable to: (if requesting through PayPal, Re-type your PayPal email)
Please email copies of your receipt(s) to firstname.lastname@example.org
or mail receipt(s) with a copy of your Submitted Reimbursement Form email
to Krista Royston, 2157 Candlewood Dr, Charlotte, MI 48813.
PLEASE NOTE: Reimbursement checks will not be issued until the receipt(s) are received.
Comments or Questions: