BUDGET/ASB APPROVAL
PERSONAL REIMBURSEMENT REQUEST
Employee Name Location
Street Address EIN
City State Zip Code
Budget Code
STORE/VENDOR
RECEIPT
DATE
DESCRIPTION LIST
LIST ITEMS PURCHASED AMOUNT
TOTAL
REMINDER:
All original, itemized receipts must be attached and submitted within thirty (30) working days of purchase.
Reimbursement must not exceed $250.00 per day (Board Policy/Rule 3310 revised 2019).
Submit original form with itemized receipts attached to the Budget/Accounting Department for approval.
Requestor Date
Supervisor Date
Site/Department Administrator Date
PAYMENT FROM DISTRICT FUNDS - SEND TO BUDGET DEPARTMENT FOR APPROVAL
PAYMENT STUDENT FUNDS, ATTACH THE REQUEST FOR PAYMENT - SEND TO ACCOUNTING FOR APPROVAL
Rev 10/2019
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Personal Reimbursements
Per Board Rule 3310 personal reimbursement for purchase of allowable district materials shall not
exceed $250 per day.
This rule applies to reimbursement requests for both district funds and student accounts.
FORM INSTRUCTIONS
Enter all information at top of form: employee name, location, address, EIN (employee
identification number) and Budget code
Each receipt must be listed separately. Include the store/vendor, receipt date; list of items
purchased (may use additional lines for items) and the amount
Attach original receipt(s)
Sign and date the Request
Obtain the Supervisor and Site/Department Administrator signatures and dates
Submit the completed form on white paper to the Budget Department
Requests for reimbursement must be submitted within 30 days
If student funds, attach the Request for Payment with all signatures
FAQs
Personal reimbursements from district funds are processed monthly.
Requests must have supporting receipts and all required signatures and Budget approval.
Requests received in Accounting by the 10
th
of month will be processed in that month;
otherwise, they will be processed in the subsequent month.
DENIALS
Requests for reimbursement will be denied for the following reasons:
Request exceeds $250 per purchase per day.
Technology related items, e.g., mouse, keyboard, cables, memory cards, etc.
Furniture and equipment, e.g., chairs, DVD players, printers, etc.
Maintenance & Operations/Custodial items, e.g., ladders, tools, etc.
Purchase shipped to location other than a district site, e.g., home address
Conference/meeting expenses should be on a Conference Form.
Foods/Snacks that violate the District’s Wellness Policy, e.g., candy, soda
Missing “Expenditure of Funds” form 3330
Rev 10/2019