Reimbursement Form

Reimbursement/Check Request Form

Use this form to be reimbursed for approved expenditures with the LHS PTO. Reimbursements must be submitted no later than May 31st of the year for which the expenses took place.

Checks may be written directly to the pertinent vendor or as reimbursement to LHS staff or PTO committee member.

Name

Person requesting the reimbursement

First Name

Last Name

Phone

(###)

###

####

Today's Date

YYYY

PTO Committee/ School Department

Is this request related to a PTO Mini-Grant

Yes

Amount to be reimbursed (total)

Check "Payable to"

Address to mail the check

Suggest LHS if a school employee

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

1st Item Cost & Description

Please list and provide a brief description of the 1st item for reimbursement. Please email receipts to "treasurer@lhspto.org". Also, please let us know if Department funds are being used to purchase the items.

Additional Item Costs & Descriptions

Please itemize list of any additional items as part of this reimbursement. Please email receipts for all items to "treasurer@lhspto.org"

Reimbursement/Check Request Form

Lexington High School PTO