Staff & Teacher Reimbursement Form

This form should be used by WUES staff members and teachers (not PARENTS/PTO) who are requesting authorization for purchase/reimbursement OR who have made an APPROVED purchase and are requesting payment/reimbursement.

Please submit this form with itemized receipts and proof of payment, if applicable. Please note that reimbursement checks will take approximately two weeks.

Date

Amount

(Reminder: No Sales Tax)

Phone

First name

Last name

Your Signature

Brief Description or Purpose of Expense

Check one:

Vendor is invoicing the school for this purchase. Invoice or Purchase Order is attached.

This expense will appear on the PTO credit card AND a copy of quote or purchase invoice is attached.

Personal reimbursement directly to individual. Original receipts must accompany this form.

Please select payment perference below: (Total must be under $600).

Paper Check (to be delivered to school mailbox)

**NEW** My Zelle Payment contact information is (phone or email):

PTO Budget Account - MUST SELECT ONE OR WRITE BELOW:

Administration

Facilities

Principal's Discretion

Technology

Educational Budget Items

Science Fund

Art

Music

Library

Professional Development

ESL Certification

SEL Expenses

Misc. Professional Development

Expense/Sub-Account:

Itemize Expenses Here (Reminder: No Sales Tax):

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

VENDOR

DATE

INVOICE #

EXPENSE DETAIL

AMOUNT

Please attach JPG or PNG file.

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