Expense Reimbursement

This form is for districts/sections who are using the State Office to administer financial functions (issuing checks to cover expenses, and depositing fees).

Name*
Person completing this form.
First Last
Email*
Type carefully, please
Expenses for:*
Select region
Activity:
Please limit each reimbursement request/form to one type (complete form again for a different activity).
List*
Summarize the purpose for each receipt (but NOT each line item on the receipt). Add a row for each receipt.
Description Total Amount
Total Expense Reimbursement*
Payee*
To whom we make the reimbursement check payable (name of person or school/organization).
Mail check to:*
- School
- Home
Receipts
Please upload receipts (otherwise, fax or mail to WHSFA office).
Drop files here or

Accepted file types: pdf, jpg, gif, png, doc, docx.
Notes

Description	Total Amount