For District Employee use only

KACD Reimbursement Request Form for Outreach & Education Funds

County Requesting Reimbursement This field is required

Date of Reimbursement Request This field is required Invalid Format

District Manager Name This field is required

District Manager Email This field is required Invalid Format

Date Event Held This field is required Invalid Format

Number of Attendees

Provide a Paragraph Description of the Event Held This field is required

Non-Federal Hours Committed to Event

Provide Actual and Total Budget Expenses This field is required

Total Reimbursement Requested This field is required

Are you receiving other funding? How much, from where, to cover what expense?

Reimbursement Payable To This field is required

Other Relevant Information