2019 Burke County School District Network – Reimbursement Form

Use this form to submit expense reimbursement requests related to your participation with PAGE Professional Learning.

Session Dates (Please do not request a reimbursement prior to the actual date of the session.)*
Select the session you wish to receive a reimbursement.
- September 9, 2019
- October 22, 2019
- February 14, 2020
- March 9, 2020
Name*
First Last
Address*
Street Address City State ZIP Code
District*
School / Location*
Email*
Enter Email Confirm Email
Phone Number*
Dinner Receipts (Enter total amount of all qualifying dinner receipts)
Reimbursements will reflect uploaded receipts (maximum $25 per dinner which includes tax and 15% gratuity). PAGE does not pay for alcoholic beverages.
Upload images of receipts (pdf, png, gif or jpg files accepted)
Drop files here or

Accepted file types: pdf, jpg, gif, png, Max. file size: 50 MB.
Number of Miles Traveled (driver only)
Mileage
Mileage is automatically calculated at the national average rate of .535 per mile.
COMMENTS: If you have a comment or question, enter it here.
TOTAL REIMBURSEMENT