Grant Disbursement Form

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Name of person submitting this form*

First Last

Email of person submitting this form*

Grant Type*

Name of Park*

Start typing to find your park

Amount of grant funds being requested*

Expenses to be reimbursed/paid*

Please upload a receipt or invoice for each expense listed below.

Date

Vendor

Description

Amount

Is this a reimbursement?*

Have you already paid for the work and are seeking reimbursement?

Yes

Supporting Documentation*

To request reimbursement, upload paid receipts.

To request direct payment of a vendor, please upload the unpaid invoice.

All vendors doing work in parks must submit proof of insurance.

*Please do not submit sensitive financial information through this website form. This includes EINs, W9s, banking details, or any other sensitive vendor/tax information.

Drop files here or

Accepted file types: jpg, jpeg, pdf, gif, pdf, xls, xlsx, doc, docx, png, Max. file size: 20 MB.

Any additional information you would like to share?

Signature*