Grant Reimbursement Form : Grants : Ogallala Public Schools Foundation

Project Name (Required)

Contact Person (Required)

Phone (Required)

email (Required)

Total Amount Requested (All Vendors) (Required)

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Vendor #1 Information (Required)

Vendor name, Address, Date Incurred, Description, Amount for this Vendor

Vendor #2 Information (Required)

Vendor Name, Address, Date Incurred, Description, Amount for this Vendor

Vendor #3 information (Required)

Vendor Name, Address, Date Incurred, Description, Amount for this Vendor

Other Party Reimbursement (not vendor) (Required)

Name, Address, Date Incurred, Amount of reimbursement, Explanation of funds to be reimbursed to parties other than vendors

Person Submitting Reimbursement Request (Required)

Date of Submission (Required)

Please note that the equipment purchased using grant funds is the property of the Ogallala Public School District. Grant funds will be distributed only after sufficient documentation of expenses has been provided to the Foundation's Board of Directors for review via a properly completed reimbusement form. Any unused grant funds will remain with the Ogallala Public School Foundation.