Odyssey PTA Reimbursement Request Form

Please use the new reimbursement request form. Contact the Odyssey PTA Treasurer with any questions.
REIMBURSEMENT REQUEST FORM

Please fill this form out as completely as possible. All purchases made by a volunteer must be authorized by an Odyssey teacher or a PTA Board member in advance. Receipts are required for reimbursement. Please direct questions to Brian Winters, Odyssey PTA Treasurer, at ospc-finance@odysseyprogram.org.
Date of Reimbursement Request*

MonthDayYear
Date
Requestor Name*
Check Payable To*
Name of Individual/Company
Address (if check will be mailed)

Street Address

Street Address Line 2

CityState

Zip Code
Description of Expense(s)/Reason for Reimbursement*
Reimbursement Amount Requested*
Please enter a number without a dollar sign.
Expense Category*

Classroom ExpenseField StudyPerformancePTA/School SupportFundraiser InvestmentOther
Cluster (if more than one cluster is selected, explain breakdown in "notes" field)*

K12345678All SchoolOther
Name of Odyssey staff or PTA board member who approved this purchase*
Payment Delivery*

Teacher MailboxLeave with School SecretaryMailOther
Take a Photo of Your Receipt (Usually for a Smartphone)
Upload a File with Your Receipt (Usually for a PC)

Upload a File

Cancelof
For PTA Treasurer use only
Check #
Payment Date

MonthDayYear
Date
MM Entry Date

MonthDayYear
Date
Should be Empty:

REIMBURSEMENT REQUEST FORM