PVA Disbursement/Reimbursement Check Request Form — Annunciation Day School

Parent Volunteer Association (PVA)

Disbursement/Reimbursement Check Request Form

Note:

Reimbursement requests should be submitted within 30 days of close of an event.
Original itemized receipt(s) or the packaging slip & invoice must be attached.
Receipts must be for the current school year.

Submission Options:

E-form will be used for reimbursements so that electronic records for all submittals may be kept.

Name

First Name

Last Name

Date Submitted

MM

DD

YYYY

Email

Phone

(###)

###

####

Pay to the order of

Please send check to

provide address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Amount of payment requested

$

If you have any questions or need to request a rush check please email Katina Tsirnikas.