Reimbursement Form for PTSA Committees

Please use this portion of the form if you have paid out of pocket and require reimbursement. Receipts or invoices need to be attached (original receipts, not copies). Please allow for a 7-day remittance in accordance with PTSA policy.

Date: _____________________________________________________________

Name: ____________________________________________________________

Address: __________________________________________________________

Amount: __________________________________________________________

Committee: ________________________________________________________

Check Payable to: ___________________________________________________

Check Request Form for PTSA Committees

Please use this portion of the form for purchases above $250 and/or ALL purchase you would like the PTSA to pay for DIRECTLY. Quotes or original orders forms need to be attached. Please allow for 7-day check issuance in accordance with PTSA policy.

Date: _____________________________________________________________

Name of Committee: _________________________________________________

Person Requesting Check: ____________________________________________

For what purpose: ___________________________________________________

Amount: ___________________________________________________________

To whom should the check be paid: _____________________________________

Address: __________________________________________________________

Questions? Contact Suzanne Howard, Treasurer at 336-926-6171 or Email Tim & Suz

For Treasurer’s Use: Check #: __________ Budget Category: ___________

Clemmons Middle School

Clemmons Middle School