WSGC Project Expense Form - Reimbursement Instructions

Team budgets must be submitted to WSGC as outlined in the award agreement letter in order for reimbursements to be issued. All costs associated with this program must be necessary and reasonable for this award, following all applicable WSGC regulations.

1. Make purchases.1.1. Teams should select one team member to oversee the budget, ensuring collective

2.1. We recommend saving receipts in a folder until time of reimbursement submission. 2.2. Number each receipt. 2.3. Circle date and total on receipt(s). 2.4. All purchase receipts must be itemized, detailing each item purchased.

3. Complete a Project Expense Form (see Tools and Tips on the WSGC website). If your expenses exceedthe allotted space on form(s), print off a second form to add the remaining expenses. Do not list both supply and travel expenses on one form.

3.1. Carefully read and follow instructions before completing form(s).3.2. List receipt(s) in numerical order. 3.3. Identify date from each receipt.3.4. List name of Vendor/Store from each receipt. 3.5. Describe the purchase from each receipt. 3.6. Provide the total expended amount from each receipt. 3.7. The "Total" box will automatically sum all receipts together -this is your total

reimbursement being requested.3.8. Initial and date each receipt with date of reimbursement submission.3.9. Sign, date, and enter your phone number.3.10. Have your team lead and advisor complete their required signatures.

4. Submit the completed form(s) and receipts in one email by the due date(s) to:Connie Engberg cengberg@carthage.edu (262) 551-6548

Do Not:1. Submit partially completed forms.2. Submit forms without all required signatures.3. Submit forms past due date(s).4. Submit "flat" per diem rate requests.

**An example of a filled-out Project Expense form and accompanying receipts can be found on the following pages

purchases/expenses do not exceed award amount.

2. Save all original digital and hard copy receipts.

Revised 08/2020

Email Form and Receipts To: Please Make Check Payable To:Connie Engberg Name:cengberg@carthage.edu Address line 1:(262) 551-6548

City, State, Zip:

Team Institution:

Rcpt #: Date Vendor/Store Amount

TOTAL

Team Member Signature Phone # Date

Team Leader Signature Phone # Date

Team Advisor Signature Phone # Date

REQUISITIONER STATEMENT: I declare (under penalties of perjury) that this account of expenses is accurate and conforms to all applicable WSGC regulations. The expenses are actual, reasonable and were personally incurred in accordance to my award letter criteria.

To receive reimbursement, this form must be submitted by each teammember who made a purchase.

NOTE: The team leader cannot be reimbursed for purchases made by team members and then distribute the money.

PROJECT EXPENSE FORM

Description

Address line 2:

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PLATTEVILLE 1700 PROGRESSIVE PARKWAYPLATTEVILLE, wr 53818

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Not valid for rebate submissions

Allo_wable returns for items on this receipt will be 111 the form of an in store credit

voucher If the return is done after 02/15/2016

LOC PRO HD EPOXY 5 MN 8020-75353-06824-3 2516713 1@15.67 15.67

N95 W/ COOLFLOW VALVE 851 JPBl-A

5622840 2@19.89 39.78

SWAN 50% ISO ALCOHOL 16 OZaom_E 5710179 2@0.88

Payment Method(s) Used; Visa - 3335

1.76

95684 08 900�;56 PM .3231

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( 608) 348 - 4888HANABER HIKE MARCHESE 1800 PR06AESSIUE PKUV PLATTEUILLE UI 53818

STI 00958 OPI 004694 TEI 18 TRN 09963 CR 3PK MASK 007535305102 6.66 X · SCTCH HASK 005113187019 4.27 XUOOD STICKS 076594016791 4.97 X

SUBTOTAL 18. 12•• UOIDED ENTRY••

UOOO STICKS 076594016791 ** UOJOED ENTRY••

SCTCH HASK 005113187019 ** UOIDED ENTRY••

CR 3PI MASK 00753530S102 CR SPK HASK 007535305102 SCTCH HASI 00�113187019 UOOO STICKS 07659t016791

4.97-X 4.27-X

8.88-X 8.88 0 4.27 0 4.97 0

18.12 SUBTOTAL TOTAL

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TCI 1222 2806 1628 5052 8486

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Bill To:

WILDMAN HOBBIES PO BOX 33 25996 N. 2750 RD

VAN ORIN,IL. 61374 LEDP 3-IL-011-54-0E-00679

PHONE 815-638-3200 FAX 815-638-3412

Sales Receipt #1970� 4/5/2011 Page

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Credit Card: $61.14 Visa

Thanks for shopping with us!

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Subtotal: $51.12 0 % Tax: + $0.00

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