PTSA Reimbursement Request

📋 All reimbursement requests must be submitted within 30 days of the expense date. Attach all original receipts. Requests without receipts may be delayed or denied. Contact your PTSA Treasurer with questions.

1 Requestor Information

Full Name *

Email Address *

Phone Number

Mailing Address (for check)

2 Committee & Event Details

Committee Name *

Event / Program Name *

Date of Event / Purchase *

Brief Description of Purpose *

3 Itemized Expenses

Description	Date	Vendor / Store	Amount ($)	Receipt?

Total Requested Amount: $0.00

4 Payment Method Preference

Paper check mailed to address above Hand-delivered check (will coordinate pickup)

5 Receipt Submission

I am attaching physical receipts with this form I will email scanned/photo copies to the treasurer Receipts are unavailable (explanation required below)

Upload Receipts (JPG, PNG, or PDF accepted)

📎

Click to upload or drag & drop

JPG, PNG, PDF up to 10MB each

Additional Notes / Receipt Explanation

6 Certification & Signature

By signing below, I certify that the expenses listed are accurate, were incurred for PTSA purposes, and that I have not been or will not be reimbursed from any other source.

Printed Name *

Date Submitted *

Committee Chair / Approver Name

Print and submit with receipts to your PTSA Treasurer, or save as PDF to email.

✅ Your reimbursement request has been recorded! The PTSA Treasurer will follow up within 5–7 business days.