KING MIDDLE SCHOOL PTA
REIMBURSEMENT and CHECK REQUEST
FORM
Thank you for your work on behalf of King Middle School and/or the King PTA. To be reimbursed
for an approved PTA expense OR to request that a check be issued on behalf of the PTA, please:
1.
FILL OUT, SIGN, and DATE this form, making sure to include a description of the Expense.
2.
Attach ORIGINAL receipts and or invoices (make copies of this form and your receipts/invoices to keep for your
records).
3.
An approved PTA expense means that it is an expense that is part of the approved budget, and falls within a
budget line item. You will need to indicate the name of the budget line item on this form, and the budget
manager for that line item must approve.
4.
If you are a member of the King Staff, Janet Levenson, Principal, must sign the form before you submit it to
the PTA.
5.
Place the form and receipts / invoices in the PTA Box – TREASURER FOLDER – in the King Front Office, or mail
the form to: King PTA Treasurer, ________________________ at ________________________________________________.
REQUESTED CHECK:
6.
Check requests can take up to 2 weeks to process.
7.
Questions? Please contact the PTA Treasurer at ptatreasurer@mlkmiddleschool.org
Amount $
Check One:
Name of Payee:
❏ Advance
❏ Reimbursement
MAIL CHECK BY FIRST CLASS MAIL TO:
Name:
Street:
City, State, Zip:
Home Phone:
Cell Phone:
DESCRIBE THE EXPENSE(S) COVERED BY THIS REQUEST AND THE APPROVED PURPOSE(S):
REQUESTER
PRINCIPAL’S APPROVAL (STAFF ONLY)
Signature:
Approval Signature:
Date:
Print Name:
Email:
Phone:
Date:
KING MIDDLE SCHOOL PTA
REIMBURSEMENT and CHECK REQUEST
FORM
Requestor Note: By signing this form, you
certify that the purchase(s) or expense(s) is / are for the
benefit of the King Middle School program described and is / are not being paid or reimbursed
from any other source.
********** FOR KING PTA USE ONLY
•
FOR KING PTA USE ONLY
ONLY **********
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FOR KING PTA USE