Chapter Education Grant (CEG) Reimbursement Request

Please note that this form needs to be completed by a member of the chapter/associate chapter Board of Governors (BOG).

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* 1. BOG Member Contact Information:

Name *

Position on BOG

Email Address *

Phone Number *

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* 2. Chapter:

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* 3. College/University Name:

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* 4. Grant Request Purpose:

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* 5. Date of Event:

Date / Time

Date

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* 6. Receipts for educational materials:

You are limited to 5 documents. Please combine multiple receipts into a single document. You must upload your documents in PDF, JPG or PNG formats. List Check Payable Legal Name of each recipient here & amount. If Multiple grants to be given - list all here with corresponding amount.

PDF, DOC, DOCX file types only.

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* 7. Further explanation of grant request purpose, if necessary:

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* 8. Officer/Recipient Contact Information (If multiple recipients please list one mailing address) :

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Chapter Education Grant (CEG) Reimbursement Request

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* 1. BOG Member Contact Information:

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* 2. Chapter:

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* 3. College/University Name:

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* 4. Grant Request Purpose:

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* 5. Date of Event:

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* 6. Receipts for educational materials:

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* 7. Further explanation of grant request purpose, if necessary:

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* 8. Officer/Recipient Contact Information (If multiple recipients please list one mailing address) :

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* 9. Officer Title if applicable:

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* 10. Requested Amount per person