Stipend Payment Request – Hermosa View & Valley Parent Teacher Organization

Please Click the Arrow to Select the Stipend *

Legal Name of Staff Member(s) Receiving Stipend & Stipend Amount *

Please enter 1 staff member per line followed by stipend amount. For Lunch Clubs only, please enter Club name. Ex: Sylvia Gluck - Card Club - $250

Materials Reimbursement Amount (Lunch Club Only - max $25)

Materials Reimbursement Receipts (Lunch Club only)

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Please attach scans or pdfs of all receipts that relate to this expense. Receipts must be signed by site administrator.

Staff Member Addresses (for submissions after end of school year ONLY)

Trimester 3/EOY checks will be mailed to staff members if Stipend Request is submitted on/after last day of school. LAST DAY to submit Stipend Requests for any school year is June 20.

Your Email *

You will receive an email copy of this submission for your records.