Scholarship Grant Expense Form

Please complete this expense form after the event for which you are receiving a scholarship grant. Show your total expenses. You will receive a check for your actual expense up to the amount of your grant.

Name/Location of the event:
Date of the Event:
Amount of Approved Grant:
Miles - Calculation done by IM-ABC Office
Rooms/motel costs:
Meals:
Other Expenses:  
Expense Amount
Total Expenses:
   
Name:
Address (where check is to be sent):
City:
State:
Zip:
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