FLEX / YES – Grant Programs Expense Report

Flex Yes – Grant Programs Expense Report

Grant Programs Expense Report

For reimbursement, please complete this form according to the Grant Program Expense Guidelines and submit with ORIGINAL ITEMIZED, NUMBERED RECEIPTS. Please provide details of your mileage request and for all trips over 50 miles one way, include an online map itinerary with mileage approximation. Mileage should be calculated at a rate of $0.575 per mile.

Expense Report #(Required)

Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Date of Activity(Required)

Location(Required)

Activity Type

Total # of Adults(Required)

Total # of Chaperones(Required)

Total Number of Grant Students(Required)

Total # of Students(Required)

Indicate Students and their Activities

Student Orientation & Meetings

Arrival

Check

FLEX #

YES #

Mid-Year

Check

FLEX #

YES #

Re-Entry

Check

FLEX #

YES #

Host Orientations

Arrival

Check

FLEX #

YES #

Re-Entry

Check

FLEX #

YES #

Enhancement Activities

Activity 1 – Semester 1

Check

FLEX #

YES #

Activity 2- Semester 1

Check

FLEX #

YES #

Activity 3- Semester 2

Check

FLEX #

YES #

Activity 4- Semester 2

Check

FLEX #

YES #

Activity Type

Other Expenses (Please Explain)

Explanation of Activities

Please choose how many expenses you are submitting(Required)

Date

Location

Explanation of Expenses

Total Expense

File

Max. file size: 80 MB.

Mileage Record Sheet

Please choose how many mileage requests you are submitting(Required)

Date

From

Description of Travel

Mileage

Auto Calculated Amount * $.0575

Section Break

Total Expenses (Calculated)

Total Mileage (Calculated)

Total Amount Due (Calculated)