Reimbursement Request Form

Reimbursement Request Form

Please submit a fully completed copy of this form for reimbursements.

A copy of the completed form will be emailed to you upon completion for your records.

Please email any questions to finance@divched.org.

Full Name
Payment Address
Select your organization:
Reason(s) for the expense:
Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
All payments to US addresses will be sent by check from Chase Bank. Please be aware of the check as it may look like advertising mail.
Foreign payments will be made by a person-to-person payment system to your email address. Please verify the email address to send the payment to below: