subject_line
Reimbursement Form
Date
*
+
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Phone
*
Email Address (that you would like to be contacted by)
*
Please itemize each expense item and submit all invoices, vouchers and/or receipts and send to PO Box 48, Waukee, IA 52213 c/o Shape Iowa. Electronic receipts can be sent to info@shapeiowa.org
Reason for Payment Item and Line Item Number
*
Travel: Advocacy (Non-Lobbying) - Line 460
Other Expense Advocacy (Non-Lobbying) - Line 470
Public Relations - Line 480
Shape Iowa Workshop - Line 566
Student Workshop - Line 567
Travel for TOY's to provide PD - Line 568
Travel Scholarship for PD - Line 595
Postage - Line 600
ED Office Expense - Line 640
ED Travel - Line 660
ED Travel (SAM) - Line 670
Supplies - Line 690
Website - Line 720
Membership Recruitment - Line 750
Convention Manager Expenses - Line 790
Leg. Board Meetings Travel - Line 800
Leg. Board Meeting Expense - Line 840
Executive Travel - Line 850
Executive Meeting Expense - Line 890
Election Expenses - Line 910
Shape Iowa Leadership DC - Line 920
Committe Travel - Line 940
Committe Meeting Expense
Amount being asked for
Reason for Payment Item and Line Item Number
*
Travel: Advocacy (Non-Lobbying) - Line 460
Other Expense Advocacy (Non-Lobbying) - Line 470
Public Relations - Line 480
Shape Iowa Workshop - Line 566
Student Workshop - Line 567
Travel for TOY's to provide PD - Line 568
Travel Scholarship for PD - Line 595
Postage - Line 600
ED Office Expense - Line 640
ED Travel - Line 660
ED Travel (SAM) - Line 670
Supplies - Line 690
Website - Line 720
Membership Recruitment - Line 750
Convention Manager Expenses - Line 790
Leg. Board Meetings Travel - Line 800
Leg. Board Meeting Expense - Line 840
Executive Travel - Line 850
Executive Meeting Expense - Line 890
Election Expenses - Line 910
Shape Iowa Leadership DC - Line 920
Committe Travel - Line 940
Committe Meeting Expense
Amount being asked for
Reason for Payment Item and Line Item Number
*
Travel: Advocacy (Non-Lobbying) - Line 460
Other Expense Advocacy (Non-Lobbying) - Line 470
Public Relations - Line 480
Shape Iowa Workshop - Line 566
Student Workshop - Line 567
Travel for TOY's to provide PD - Line 568
Travel Scholarship for PD - Line 595
Postage - Line 600
ED Office Expense - Line 640
ED Travel - Line 660
ED Travel (SAM) - Line 670
Supplies - Line 690
Website - Line 720
Membership Recruitment - Line 750
Convention Manager Expenses - Line 790
Leg. Board Meetings Travel - Line 800
Leg. Board Meeting Expense - Line 840
Executive Travel - Line 850
Executive Meeting Expense - Line 890
Election Expenses - Line 910
Shape Iowa Leadership DC - Line 920
Committe Travel - Line 940
Committe Meeting Expense
Amount being asked for
Reason for Payment Item and Line Item Number
*
Travel: Advocacy (Non-Lobbying) - Line 460
Other Expense Advocacy (Non-Lobbying) - Line 470
Public Relations - Line 480
Shape Iowa Workshop - Line 566
Student Workshop - Line 567
Travel for TOY's to provide PD - Line 568
Travel Scholarship for PD - Line 595
Postage - Line 600
ED Office Expense - Line 640
ED Travel - Line 660
ED Travel (SAM) - Line 670
Supplies - Line 690
Website - Line 720
Membership Recruitment - Line 750
Convention Manager Expenses - Line 790
Leg. Board Meetings Travel - Line 800
Leg. Board Meeting Expense - Line 840
Executive Travel - Line 850
Executive Meeting Expense - Line 890
Election Expenses - Line 910
Shape Iowa Leadership DC - Line 920
Committe Travel - Line 940
Committe Meeting Expense
Amount being asked for
Reason for Payment Item and Line Item Number
*
Travel: Advocacy (Non-Lobbying) - Line 460
Other Expense Advocacy (Non-Lobbying) - Line 470
Public Relations - Line 480
Shape Iowa Workshop - Line 566
Student Workshop - Line 567
Travel for TOY's to provide PD - Line 568
Travel Scholarship for PD - Line 595
Postage - Line 600
ED Office Expense - Line 640
ED Travel - Line 660
ED Travel (SAM) - Line 670
Supplies - Line 690
Website - Line 720
Membership Recruitment - Line 750
Convention Manager Expenses - Line 790
Leg. Board Meetings Travel - Line 800
Leg. Board Meeting Expense - Line 840
Executive Travel - Line 850
Executive Meeting Expense - Line 890
Election Expenses - Line 910
Shape Iowa Leadership DC - Line 920
Committe Travel - Line 940
Committe Meeting Expense
Amount being asked for
Mileage Reimbursement (please enter total miles being asked for reimbursement)
Per Mile ($0.24)
Current Total of Reimbursement Being Asked for:
$0.00
Calculate
Required
*
I have made sure that all information is current and correct.