am employed by the County District School Board or by the Charter School as a full-time classroom teacher. I
acknowledge that Florida Teachers Classroom Supply Assistance Program funds are appropriated by the
Legislature for the sole purpose of purchasing classroom materials and supplies to be used in the instruction of
students assigned to me. In accepting custody of these funds, I agree to keep the receipts for all expenditures for
no less than 4 years. I understand that if I do not keep the receipts, it will be my personal responsibility to pay any
federal taxes due on these funds. I also agree to return any unexpended funds to the district school board at the
end of the regular school year for deposit into the school advisory council account of the school where I was
employed at the time I received the funds or for deposit into the Florida Teachers Classroom Supply Assistance
Program account of the school district in which the charter school is sponsored, as applicable.
I,
School
* The term "classroom teacher" includes certified teachers employed on or before September 1 of each year
whose full-time job is the classroom instruction of students in grades Pre-K through 12, and full-time media
specialists and guidance counselors who serve students in grades Pre-K through 12.
FOR INTERNAL USE ONLY
Paid by Check #
PBSD 2262 (Rev. 7/11/2017) ORIGINAL - Accounting Services COPY - file
Complete the top portion of the form. Attach to the Check Request (PBSD 2260).
CHARTER SCHOOL USE ONLY
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
ACCOUNTING SERVICES
Florida Teachers Classroom Supply
Assistance Program Affidavit
Job Title
Employee ID#
Signature Date
Check Date
,
