Granite Falls School District Expense Claim Form by icu87693

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									                 Granite Falls School District Expense Claim Form

Employee                                                          Position

Location                                                          Date



Expense Claim (List additional expenses on back of form)
             Please allocate reimbursement claim between Supply and Tuition Stipends when combining.
 Date          Expense                                    Amount                 Account Code




                                                          Total Supply
                       Attach itemized receipts           Total Tuition

Mileage Expense Claim (List additional expenses on back of form)
   Date            Destination            Purpose of Trip         Miles        x's .50         Account Code




                                                                              Total

Tuition Expense Claim
            Attach proof of payment and a grade or other proof of satisfactory completion.
                 Please allocate reimbursement claim when combining Supply and Tuition Stipends.
 Course Number                      Course Title                                Credits                Tuition Fee




                                                                                Total Supply
                                                                                Total Tuition

I hereby certify that I have completed the above listed course(s) and that I have paid the tuition. I request
reimbursement for the tuition costs (not to exceed $250 or $500 for years 2-5) per 7.10 of the Collective
Bargaining Agreement.

I hereby certify that this is a true and correct claim for approved expense incurred by me and that no
payment has been received for them.
                                                                                  Grand Total


Supervisor Signature                                              Employee Signature

Date                                                              Date


Revised 12/16/2009                                                                                        Page 1
                 Granite Falls School District Expense Claim Form



Expense Claim
Attach itemized receipts
                                          Comp Tax
                                          Office Use
    Date                   Expense           Only       Amount               Account Code




                                                       Subtotal




Mileage Expense Claim
   Date            Destination       Purpose of Trip   Miles      x's .50      Account Code




                                                                  Subtotal




Revised 12/16/2009                                                                    Page 2

								
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