Family Name______________________________

	Attach original receipts and mail to Attention: Evelyn Frenette Nechako Electronic Busing Program Bag 8000 187 East Victoria Street Vanderhoof, BC V0J 3A0
INSTRUCTIONS 1. Number each original receipt. 2. Complete this form, including place of purchase, description of item/activity purchased, and subject area covered. 3. State price of item claimed. 4. Attach receipts. 5. If you need more space to list receipts, use the back of this form.

No.	PURCHASED FROM	ITEM DESCRIPTION	AMOUNT	Please indicate subject area purchase supports. This must be included on your SLP.
				Language Arts/ Social Studies	Math Science	PE/ PP/ CAPP	Fine Arts/ Applied Skills	Technology	Other – please specify
1
2
3
4
5
6
7
8
9
KTOTAL (Sub) =

No.	PURCHASED FROM	ITEM DESCRIPTION	AMOUNT	Please indicate subject area purchase supports. This must be included on your SLP.
				Language Arts/ Social Studies	Math Science	PE/ PP/ CAPP	Fine Arts/ Applied Skills	Technology	Other – please specify
10
11
12
13
14
15
16
17