Parent Support Reimbursement Form

This form must be filled out and submitted with each reimbursement request.

Student’s Name: _______________________________________________

Total amount of receipts being submitted: $_________________

Submitting for QTR (circle one): 1^st   2^nd       3^rd        4^th

Specifically, how are these purchases related to your students’ educational plan?

Attach original receipt(s) and use the following checklist to be sure all receipts include the following information: 

• Items Purchased                    

• Name of Vendor                    

• Date of Purchase                   

• Amounts of Purchase              

• Signature of Parent                 

Parent support funds are processed on a quarterly basis.  Please allow several weeks for processing and keep a copy of the receipts for your own records. Submit completed forms with receipts attached to Stacy Eldredge.

If you have any questions please do not hesitate to call 206.491.9034 or email eldredges@riverview.wednet.edu