My expenses were incurred 30 days ago or less: *

Yes

No

My Name *

First Name

Last Name

My reimbursement request is for: *

$99 or less

$100 or more

A Zoom account [in any amount]

My expense was $100 or more, and I obtained prior approval for my expense:

Yes

No

If my answer to the previous question is "Yes," I obtained prior approval for my expense:

At a Board meeting

By email confirmation from the Board or Executive Committee

Other (explain below)

FOR INDIVIDUAL TUTOR EXPENSES: I am requesting reimbursement for the following expenses for my class *

Supplies (markers, white boards, props, etc.)

Books/ / ebooks

Newspapers

Other (explain below)

Not applicable

FOR CENTER DIRECTOR EXPENSES ONLY: I am requesting reimbursement for the following expenses for my Center *

Postage / printing / copies

Supplies (markers, white boards, props, etc.)

Books / ebooks

Newspapers

Other (explain below)

Not applicable

FOR BOARD MEMBERS EXPENSES ONLY: I am requesting reimbursement for the following Board-related expenses *

Postage / printing / copies

Supplies (name tags, markers, props, etc.)

Venue / entertainment / speaker

Refreshments / food / caterer / decorations

Website / other technology or software

Other (explain below)

Not applicable

FOR ZOOM ACCOUNT PURCHASES ONLY: I am requesting reimbursement for the following pre-approved expense for the cost of a Zoom account: *

A one-month subscription

A multiple-month (but not annual) subscription

An annual subscription

Not applicable

My receipts *

Are being emailed to Aparna [address above]

Are being mailed to the SCLC P.O.Box

Make check payable to

First Name

Last Name