Disbursement Form - Park Pride

Use this form to request that Park Pride disburse funds from a grant. Please be sure to provide appropriate documentation.

"*" 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*

If you have an Activation grant through the Park Stewardship Academy, please select Shall Change.

Name of Park*

Start typing to find your park

Amount of grant funds being requested*

This field is hidden when viewing the form

Amount of matching funds being submitted with this request

Required if you received a Park Pride matching grant. Please enter the amount of matching funds being submitted for this request (above field).

Expenses to be reimbursed/paid*

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

Date

Vendor

Description

Amount

Is this a reimbursement?*

A reimbursement does not require a W-9 or Certificate of Insurance (COI).

Yes

Supporting Documentation*

This includes receipts, invoices, W-9, Certificate of Insurance, ACH, and proof of payment for reimbursement such as redacted bank statements.

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*