Teacher Reimbursement/
Payment Request Form

You may fill out this form online or download the PDF and submit to the PTA Treasurer’s inbox in the main office. If you have any questions, email the PTA Treasurer here: mimstreasurer@gmail.com.

Person Requesting Payment

First Name

Last Name

Date

YYYY

TOTAL Amount Requested

Purpose of expenditure

Please be specific: supplies, grant name, travel expense, continuing education, etc.

Make Check Payable to:

Name (please print):

Phone

(###)

###

####

PLEASE UPLOAD/ATTACH ALL RECEIPTS, INVOICES, ORDER FORMS, ETC.

Expenses cannot be reimbursed without this original documentation. If item has already been purchased, please upload/attach receipt(s) to this form. Otherwise, provide receipt(s) as soon as possible after purchase.

Teacher Reimbursement/Payment Request Form

Mandela International Magnet School

Teacher Reimbursement/
Payment Request Form