Reimbursement Form

Request a Reimbursement from CLIPCO

CLIPCO Reimbursement Form

Required *
Full Name*
Check will be payable to this name
Check will be mailed to this address
Email address*
All communication and a .pdf copy of this request will be sent to this email address
School* Meyerholz Elementary School
Miller Middle School
Combined School (ASEP, Graduation, CLIPCO Administration Expenses)
Description of Purchase* Please list general description of expenses and purpose
Amount ($)* If you have multiple receipts, please add up your total amount and list here
See Category and Subcategory List below. If you have multiple expenses in different categories, you must submit a new form for each category.

Donation Categories

CLIPCO Administration Costs
Community Events
DGC (Direct Give Campaign) Expenses
President Administration Exp.
Postage/Mailing service

Instructional Materials
CLIP Art Material (K-5)
CLIP Art Material (6-8)
Grade K - Teacher Reimbursable
Grade 1 - Teacher Reimbursable
Grade 2 - Teacher Reimbursable
Grade 3 - Teacher Reimbursable
Grade 4 - Teacher Reimbursable
Grade 5 - Teacher Reimbursable
Grade 6 - Teacher Reimbursable
Grade 7 - Teacher Reimbursable
Grade 8 - Teacher Reimbursable
Elementary Library Books (K-5)
Books & Supplemental Materials (6-8)

Professional Development
Professional Development

Training and Conferences
Training and Conferences



ASEP - unallocated expense
ASEP - Chinese Calligraphy Class
ASEP - Chinese Dance Class
ASEP - Chinese Lion Dance Class
ASEP - Chinese Percussion Class
ASEP - Chinese Wushu Class
ASEP - Go Monday
ASEP - Flute Class
ASEP - Baking
ASEP - Erhu

Graduation Expenses

CLIPCO T-shirt Expenses
CLIPCO T-shirt Expenses