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Using the Arts to Educate

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MUCAI Academy Purchase Reimbursement Form

First name*

Last name*

Address (To where do you want your reimbursement check mailed?)*

Email*

Phone*

Relationship with MUCAI Academy*

Item(s) Purchased*

Reason for Purchase*

Date of Purchase*

Was this purchase requested/pre-approved by the Director?*

Yes

No

Cost of Item(s)*

Upload Receipt*

I understand and accept that MUCAI Academy will only reimburse for purchases over $10, unless requested by the Director and that MUCAI Academy will not reimburse for any purchases I make unless requested or pre/approved by the Director. Pre-approvals must be in writing in an official MUCAI Academy communication forum (messaging system, email, text, etc) to be valid.

Legal Signature*

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