Reimbursement Form, 2024-2025

This online request form may be used to request payment or reimbursement of funds paid for PTA-approved services or goods.

Instructions

Please fill out completely with a description of reimbursement and a breakdown of expenses.
Attach up to 5 files/pictures/scans of all receipts and supporting documentation.
If you would like us to mail the payment directly to the vendor, please include the mailing address in the Description/Purpose box below.
A receipt of your submitted request will be e-mailed to you (please keep it for your records).
The treasurer will e-mail you when your check has been mailed to the vendor.
Questions? Please e-mail our PTA treasurer at treasurer@topta.org.

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Payment/Reimbursement Request

Total Amount Requested for Reimbursement/Payment:

Payment or Reimbursement

Select "Payment" if you are requesting the PTA to issue a check to a person or vendor
Select "Reimbursement" if you have already paid for a product or service and you wish to be compensated

Check made payable to:

Choose a teacher or staff person, or a PTA member from the drop-down list.

If you are seeking payment for a vendor or service, please list the name of the vendor or service below.

Other Vendor or Service Provider

Should the check be mailed directly to the vendor/payee or sent to the school site?

Address where the check will be mailed.

Listed address where the check will be mailed.

Committee/Program/Event

Select the expense category for this payment/reimbursement.

Description/Purpose:

Reimbursement/Payment Account

List the account from which you are seeking reimbursement. Funds may be dispersed from the

For example, if you are seeking reimbursement from the Principal fund, please obtain approval from the Principal before submitting the form.

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Attach Receipt/Invoice #4

Attach Receipt/Invoice #5

Date Check Needed (please allow at least 1-2 weeks if possible):

Treasurer Approval

Date Check Issued:

Check Number:

Notes:

Recorded in Journal

Is this item recorded in the journal?

Thank you for submitting your reimbursement/payment request. If we have any questions, we'll reach out.