CDS
CPC
FY’06 Application for
Reimbursement for Field Trip Costs
for CPC Subsidized
Children
This form is to be submitted for
uncollected field trip/enrichment costs for CPC children enrolled, incurred
between 7/1/05-6/30/06. We reserve
the right to verify attendance of each child on the date of field
trip/enrichment program from attendance sheets submitted to Self Help
Inc.
Program Name:
- Description of Field Trip/Enrichment Program
Date of Trip/Program
Names of CPC children who participated
Cost per child $
x
total# of CPC children
= requested reimbursement $
- Description of Field Trip/Enrichment Program
Date of Trip/Program
Names of CPC children who participated
Cost per child $
x
total# of CPC children
= requested reimbursement $
- Description of Field Trip/Enrichment Program
Date of Trip/Program
Names of CPC children who participated
Cost per child $
x
total# of CPC children
= requested reimbursement $
Please make copies of this form if you have additional field trip/enrichment reimbursement requests
Total amount of Reimbursement $
Reimbursement should be made out to the following:
Program/Person
Name:
Address:
Copies of proof of payment for each trip/enrichment program must be submitted with this application by June 30, 2006. Applications will be processed on a first come first serve basis. Reimbursement is dependent on funding available
Applications should be sent
to:
Self Help Inc./CDS CPC