Request for Disbursement

Please select which best applies best to you:

I am a Brooks teacher
I am a volunteer

Mini-Grant Guidelines:

Individual Classroom/teacher grant project up to $300.00

Entire grade grant project up to $900.00

Department Project (Reading, Math, Science, etc.) can exceed $1,000 but no more than $1,200

If these amounts are within your needed range, please click Next to proceed

Please select *

I am seeking a PTA mini-grant
I am seeking a field trip reimbursement or advance payment
I am seeking funding from the Teacher General Allocation Fund
I am seeking reimbursement for a different PTA Pre Approved Expense

Teacher General Allocation Fund permits up to $200 in disbursement for supplies for instruction

Name *

First

Last

Email *

Grade Taught or Relationship with School *

Total Grant Amount *

Amount of grant your group is applying for

Total Field Trip Amount *

Total Amount of reimbursement or advanced payment for field trip you / your group is requesting

Total Funding Requested *

Teacher General Allocation Fund permits up to $200 in disbursement for supplies for instruction

Description of the Project or Item *

Name *

First

Last

Please make the check payable to the name provided above.

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Justification *

Please explain how it fits in the curriculum

Students Affected and Benefit *

Number of students that will benefit from this project and how will they benefit

Total

$ 0.00

Date Purchased *

Date of purchase

Item #1 *

Name of item

Place of Purchase #1 *

Location or website of purchase

Amount #1 *

Amount paid

Date Purchased #2

Item #2

Place of Purchase #2

Amount #2

Date Purchased #3

Item #3

Place of Purchase #3

Amount #3

Date Purchased #4

Item #4

Place of Purchase #4

Amount #4

Date Purchased #5

Item #5

Place of Purchase #5

Amount #5

Total Requested Refund

$ 0.00

Project to Credit *

Fundraising
Community Building
PTA Activities
School Support
Other

Please check which project(s) to be credited. See listing below for guidance.

Fundraising: Blessings-in-a-Backpack, Community Outreach, Gala, Yearbook

Community Building: Back to school picnic, community socials, fall festival, volunteer appreciation

PTA Activities: Health and Wellness, Odyssey of the Mind, Outdoor classroom/garden Playground, Reflections, Spelling Bee, WatchDOGS

School Support: Achievement Gap, Book Fair, Gift of Learning, Mentoring, Field Day, Mini Grants for teachers Field Trip, Jamestown, Room Parent, Teacher Allocation, PBIS, Student Council Association

Other: Programs, Babysitting, Other PTA Admin (please specify)

Other Project (Please specify)

Detailed Explanation (Activity, Event, etc.) *

Explanation of Cost *

Please describe how the funds will be used, or have been used for the field trip.

Need By Date

If this is an advanced payment request, please enter the date when payment is needed.

Certification: The expenses listed above were incurred in connection with authorized PTA work and were not otherwise reimbursed to me.

Approved by:

Please provide name of PTA EC member who approved this request. “President” can be listed for pre-approved categories in PTA budget.

Documentation *

Click or drag files to this area to upload. You can upload up to 15 files.

Please upload receipt(s) or bill(s) to this form. Reimbursement will not be provided without documentation.

Signature