Fillable MUSCOGEE CREEK NATION JOM SCHOOL PROGRAM Inventory Listing

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MUSCOGEE CREEK NATION JOM SCHOOL PROGRAM Inventory Listing

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MUSCOGEE CREEK NATION
JOM SCHOOL PROGRAM
FY ___
Inventory Listing
School Name
Please complete and submit to the Creek Nation JOM Office. A review of your FY 2017 claims will
be compared to assure that all items purchased by your JOM program have been listed. If an item
was a shared cost with another program, please indicate. Please email the completed form to
pneal@mcn-nsn.gov or bproctor@mcn-nsn.gov
purchase
order #
amount
of item
cost
shared
w/what
program
actual cost to
JOM program
School District tag
number
location of item
I hereby certify that the Johnson-O’Malley Program has purchased the above items and that they are
tagged with a school district ID number and that the items are being used within the school district to the
benefit of the JOM students. I also certify that the above items are not being for personal use and that
the above items are remaining on school district property at all times.
I also certify that if for some reason the JOM Program is dissolved within this school district that all JOM
inventory remains the property of the Muscogee Creek Nation JOM Program.
IEC Chairperson date School Administrator date
kc/inventory form
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MUSCOGEE CREEK NATION JOM SCHOOL PROGRAM Inventory Listing

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Completed 1 February 2022

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