Purchase/Reimbursement Form

Teacher Details

Teacher’s Name:

Classroom:

Date of Purchase:

MM

DD

YYYY

Purchase Details Table

Item Purchased

Quantity

Price per Item

Total Amount

$

Reason for Purchase

Totals

Total Spent:

$

Reimbursement Requested:

Name / Signature of Teacher:

Budget Check-Off

$25 Weekly Allowance Used?

Running Total for the Month:

Approval Section

Approved By (Admin Name/ Signature):

Date Approved:

MM

DD

YYYY

Date Reimbursed:

MM

DD

YYYY