C.D.S.C.A. TREASURER Carlos D. Rosa
CDSCA REIMBURSEMENT FORM*
2004 - 2005
School: _______________________________Phone: ( __ __ __ ) __ __ __ - __ __ __ __
Vender: _________________________________________________________________
Vender Address or Phone #: _________________________________________________
Item and Description Unit Unit Price Quantity $ Amount
* Note: Please attach receipt to form Taxes (if applicable)
Grand Total
Requested by: _________________________________________ (Student Council Officer)
Approved by: _________________________________________ (Student Council Advisor)
Date: ___ / ___ / ___
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
FOR OFFICE USE ONLY
Approved for reimbursement on: ___ / ___ / ___
Issued Check #: ________________________________ Date: ___ / ___ / ___
CDSCA Treasurer: _________________________________________
Treasurer's Advisor: ______________________________________
Executive Director: ________________________________________