Odyssey PTA Reimbursement Request Form

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 Dan Soltesz, Odyssey PTA Treasurer, at dan.soltesz@odysseyprogram.org.
Date: *

Month Day Year
Date Date Picker Icon
Submitted by: *

First Name Last Name
Odyssey Staff or PTA Member Authorizing Purchase(s): *

First Name Last Name
Description of Expense(s) *
Expense Category *

Classroom Expense Field Study Performance PTA/School Support Fundraiser Investment
Cluster (if more than one cluster is selected, explain breakdown in "notes" field) *

K12 345 678 All School
Reimbursement Amount Requested *
Please enter a number without a dollar sign.
Payment Delivery *

Teacher Mailbox Leave with School Secretary Mail

Address (if check will be mailed)

Name of Individual/Company to be Reimbursed
Street Address
City	State
Zip

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REIMBURSEMENT REQUEST FORM