Submit to the Superintendent, who will include this request in the monthly list of bills presented to the School Board. Please print and attach receipts for all expenditures. Use of this form is required by 2:125-E3, Resolution to Regulate Expense Reimbursements. Please print.

Name:                                 

Title/Office:             

Travel Destination:                        

Purpose:             

Departure Date:                         

Return Date:         

Request Date:     

☐  Receipts attached                                   

☐  Estimated expenses attached (Completed 2:125-E2, Board Member Estimated Expense Approval Form)(pre-approval is required for federal and State grants).

☐  Approved expense advancement (voucher) attached, if applicable* (Completed 2:125-E2, Board Member Estimated Expense Approval Form.)

Submitting Board Member’s Signature    Date

Superintendent Signature    Date

School Board Action:    ☐ Approved            ☐ Denied

            ☐ Approved in Part        ☐ Exceeds Maximum Allowable Amount

☐ Grant Funding Source (If applicable):  __________________________

Comments:______________________________________________________________________________________________________________