Expense Voucher for JPA & All-State Jazz Clinic – South Carolina Band Directors Association

Use this form to submit an expense voucher for the Jazz Performance Assessment or the All-State Jazz Clinic.

I am a...(Required)

JPA Adjudicator

SCBDA Worker/Member

All-State Jazz Clinician

I am seeking reimbursement for:(Required)

Check all that apply.

Mileage

Other Expenditures

Travel Expenses

Automobile Travel FROM(Required)

Automobile Travel TO(Required)

Enter the number of ROUND TRIP miles.(Required)

SCBDA Mileage Rate: .37 per mile. Round-trip mileage is capped at $50.00. Please complete the form with all the pertinent information, understanding that mileage will be capped at $50.00.

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Mileage Rate(Required)

Please enter a number from .37 to .37.

Mileage Price(Required)

Price: $0.00

Enter the number of ROUND TRIP miles.(Required)

SCBDA Mileage Rate for JPA Adjudicators and All-State Jazz Clinicians: .58 per mile.

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Mileage Rate(Required)

Please enter a number from .58 to .58.

Mileage Price(Required)

Price: $0.00

Mileage Cap Max

Price:

Other Expenses

Additional Expenditure 1(Required)

Enter a description of the expense.

Amount 1(Required)

Enter an amount for this expense.

Additional Expense 1 Receipt(Required)

Please upload a receipt for this expenditure.

Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.

Do you have any other eligible expenditures?(Required)

Yes

Additional Expenditure 2(Required)

Enter a description of the expense.

Amount 2(Required)

Enter an amount for this expense.

Additional Expense 2 Receipt(Required)

Please upload a receipt for this expenditure.

Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.

Do you have any other eligible expenditures?(Required)

Yes

Additional Expenditure 3(Required)

Enter a description of the expense.

Amount 3(Required)

Enter an amount for this expense.

Additional Expense 3 Receipt(Required)

Please upload a receipt for this expenditure.

Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.

Requester's Information

The check should be made payable to:(Required)

The check should be mailed to:(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Please provide your e-mail address should we have a question during processing this voucher.

Phone(Required)

Please provide your phone number should we have a question during processing this voucher.

Total

Total Reimbursement Request