You can print this page or download the .docx version below and submit it by email (with your receipt scanned) or as a hard copy to Sue Nishi (thenishis@comcast.net), Treasurer, to her PTO mailbox in the hall across from the main office. For questions please contact Sue.Angell
PTO 2012-2013
Reimbursement/Check Request Form
Make Check Payable to: __________________________________________
Address: __________________________________________
__________________________________________
Amount: $____________________
Date Needed: ____________________
Submitted by: __________________________
Email: __________________________
Phone: __________________________
Committee, Event or Purpose (please circle one):
Grocery Greenbacks Ice
Cream Social
Talent Show Movie
Night
T-shirt sales Book
Drive
5th Grade Trip Boxtops
Directory PTO
Administrative
Library Teacher
Appreciation
Science Olympiad Graduation
Fall Picnic International
Night
Disability Awareness Mission
Based Books
Teacher Allowance (indicate classroom:____________________)
Room Parents (indicate classroom:_________________________)
Other (please explain):______________________________________________
*** Please attach all original receipts or invoices ***
Leave in
PTO Treasurer mailbox
This form
must be completed and submitted before a check can be issued. Thank you!
Below to
be completed by Treasurer
Check #:
________________________
Date
Issued: _____________________
