Eastmont School District
Employee MISCELLANEOUS Reimbursement Form
Employee Name					District Office Use:
Home Address					Date Received:
City, State					Total Reimbursement:
1. Original Receipts must be attached this form for proper reimbursement.
2. The Purchase Order process should be used when at all possible.
3. Reimbursements to employees will be reviewed to ensure the purchase order process was not circumvented.
Purchase	Vendor Name/	Description
Date	Purchased From	of Item(s) Purchased			Budget Code	Total Dollars
					Grand Total
1. Employee and Supervisor signatures are required.  Incomplete forms will be returned to employee.
2. Supervisor's signature is person authorizing reimbursement, i.e. program director or principal.
3. Budget Code to be completed by the Supervisor.
Employee Signature		Date			Supervisor  Signature*	Date
					* Note: The materials/products/services purchased
					were preapproved and are being expended
					against an established budget code with
					available funds.