Springfield Public Schools R12
Kraft Administrative Center
•
This form should only be used for NON-TRAVEL
RELATED expense reimbursement from Title IIA
Funds.
•
Requestor must be set up as a Vendor with the SPS
Finance Department PRIOR to submitting a
reimbursement request. Requestor MUST send a
completed W-9 form to the SPS Title IIA Program
Coordinator.
•
Reimbursement request MUST include detailed
receipts for ALL requested reimbursement
amounts. (items purchased, date and location of
purchase, line item cost of each item purchased)
Learning Support and Partnerships
1359 E. St. Louis St
Springfield, MO 65802
Phone: 417-523-0315
Requestor’s Name, Address, & Phone#_____________________________________________
Name of School:________________________________________________________________
Description
Cost
Total Reimbursement Request:
Signature of Person Submitting Request
Requestor’s Vendor Number
Signature Non-Public School Administrator
SPS Budget Code
Executive Director, Learning Support and Partnerships
0.00