PROJECT PRIME/ALGEBRA FOR ALL SUBSTITUTE REIMBURSEMENT INVOICE FORM
PUT YOUR MATHEMATICS AND SCIENCE CENTER’S NAME HERE!
TO:
Wayne RESA’S Mathematics and Science Center, 33500 Van Born Road, Wayne, MI 48184, Attention: Nanci Mitchell
FROM:
Put your Mathematics and Science Center’s name here and indicate how the check should be addressed from
Wayne RESA and indicate where it should be mailed.
RE:
Substitute Reimbursement for Project PRIME/Algebra For All
*The amount of substitute reimbursement that can be dispersed for any individual participant is 6 days at the district’s daily substitute rate not to
exceed $90. Each satellite site is responsible for paying the districts first, then requesting reimbursement from the project. Enter the monetary
amount in each cell.
Teacher’s Name
1.
2.
3.
4.
5.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
6.
7.
8.
9.
10.
11.
12.
13.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
14.
15.
16.
17.
18.
19.
20.
21.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
22.
23.
24.
25.
26.
27.
28.
29.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
30.
31.
32.
33.
34.
35.
36.
37.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
38.
39.
40.
41.
42.
43.
44.
45.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
46.
47.
48.
49.
50.
51.
52.
53.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
54.
55.
56.
57.
58.
59.
60.
61.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
62.
63.
64.
65.
66.
67.
68.
69.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
70.
71.
72.
73.
74.
75.
76.
77.
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
Teacher’s Name
School and District
Or
Where check
should be sent
PRIME/AFA
SESSION #1
@ daily rate
PRIME/AFA
SESSION #2
@ daily rate
PRIME/AFA
SESSION #3
@ daily rate
PRIME/AFA
SESSION #4
@ daily rate
PRIME/AFA
SESSION #5
@ daily rate
PRIME/AFA
SESSION #6
@ daily rate
TOTAL PER
TEACHER FOR
DISTRICT
REIMBURSEMENT
(NOT TO EXCEED
$540 PER
TEACHER)
78.
79.
80.
81.
82.
83.
84.
TOTAL TO BE REIMBURSED TO THE MATHEMATICS AND SCIENCE CENTER
SATELLITE SITE FOR SUBSTITUTES FOR PROJECT PRIME IS:
$ ________.00