Approved Expense Reimbursement Request - Berkeley Public Schools Fund

Name*

Full name of person requesting reimbursement.

First Last

Email*

Phone*

Name of payee (if different)

If check is to be made out to someone other than the you, please provide the payee name. If left blank, check will be made out to your name.

First Middle Last

Address (check will be sent here)*

Street Address City State / Province / Region ZIP / Postal Code

Amount requested*

Amount that you would like to be reimbursed for.

Reason for payment*

Please describe what the reimbursement is for.

Who approved this expense?*

Name of person or program that gave you approval to request reimbursement for this expense.

Copy of receipt(s)

If you have a paper receipt, please scan or photograph and attach a copy here (filetypes accepted are jpg, gif, png, pdf). If you have a receipt in email, you can just forward the email to schoolsfund@berkeley.net.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Notes

Provide any additional information here.

Phone

This field is for validation purposes and should be left unchanged.