Teacher Reimbursement Request Form

This form is for teachers to submit receipts for reimbursement from the Hurlbutt PTO Teachers Discretionary Fund. Each teacher is eligible for $100 per school year.

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach up to 5 files/pictures/scans of all receipts and supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurer will e-mail you when your check is ready in your mailbox.
Questions? Please e-mail our treasurer at treasurer@hurlbuttpto.com.

Check made payable to:

Should the check be mailed or dropped off at school? (reset)

Dropped at School Mailed to Home

Address

If you would like your check to be mailed, please provide your addres.

Total Amount Requested for Reimbursement/Payment:

(Maximum reimbursement - $100 per school year)

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Attach Receipt/Invoice #4

Attach Receipt/Invoice #5