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Grant Reimbursement

Surprise Lake Middle School – Partners In Education

Teacher Grant Reimbursement Form

 

 

·         Fill in the information requested on this form

·         Staple your receipts to the form

·         Submit form to the PIE Treasurer
(PIE Mailbox)

 

Your Name: __________________________________________   Phone: _____________________

 

Email: ______________________________________________

 

Amount Requested: ___________________________________

 

Check to be made out to: ____________________________________________________________

 

Address (if check needs to be mailed):  _________________________________________________

 

                                                                            __________________________________________________

 

 

Signature: ________________________________________   Date:  _____________________________

 

*************************************************************************************

Please Do Not Write Below Line – For Treasurer’s Use Only

 

Date:  ____________  Check Number: ____________  Amount: _________

Issued To: _____________________________________________________

Category: _____________________________________________________

Treasurer’s Signature: ___________________________________________

 

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