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Reimbursement Form

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 (, 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: _____________________

Unknown user,
Oct 3, 2012, 7:29 AM