Tilden PTSA Reimbursement Form
Teacher Education Resources
Date: ________________
Requested By: ___________________________________
Amount Requested: $__________________
Address: _______________________________________
_______________________________________
Phone: ________________________
E-mail: ________________________
Signature: ______________________________________
In order to be reimbursed, you must have the proper documentation
(i.e., receipt / bill / invoice / statement) attached to this form.
All requests should be left in the PTSA Treasurer’s box in the main office. You may
contact the treasurer, Kristen Mirsky, by email at [email protected] or by
calling 301‐881‐8892. Your check will be put in your mailbox when it is ready.
*** DO NOT FORGET TO ATTACH RECEIPTS***
For Treasurer’s use only
Paid by check number: __________________ Date: __________________