Classroom Grant Check Request - Berkeley Public Schools Fund

Project Coordinator*

First Last

Email address*

Project Title*

Grant title as it was listed on your grant application

School*

Indicate school that grant was designated for

School year for this grant*

Please enter the academic year that this grant was awarded for.

Grant number*

Enter grant number as specified in the email you received about your grant award (e.g. 1-001)

Description of Reimbursement or Other type of payment*

Please describe the reason for this payment.

Amount of this payment*

Specify the amount of payment. DO NOT INCLUDE $-SIGN OR COMMA.

Are you the payee or is it someone else?*

Please indicate if this payment is to you, to another person that is making purchases for your grant, or to a vendor.

Check to be made out to:*

First Last

Check payable to*

Provide the name of the company or organization that the check should be made payable to.

Address of payee:*

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

Email address of payee*

We need to have payee contact information in case we have any questions for them.

Phone number of payee*

We need to have payee contact information in case we have any questions for them.

Where should we send the check?*

We can mail the check directly to the payee, send it to you at your BUSD location (so you can give it to payee), or hold the check for pickup in our office.

Mail check to payee at address above
Mail check to me at school
Pick up the check

Payment Invoice or Other Documentation*

If you have an invoice or email or other documentation that specifies the payment information, please attach below or email it to us at schoolsfund@berkeley.net. For payments to an organization, it helps them match the payment with the specific service provided. Mark any that you will be providing.

Attach invoice or other documentation here

Please attach any invoice, receipt or other payment documentation here.

Drop files here or

Max. file size: 50 MB.

Additional Payment Instructions

If you have other special instructions or questions, provide details here.