Clay Leadership Development Grant and Endowed Circle Grant Report and Reimbursement

Clay Leadership Development Grant and Endowed Circle Grant Report and Reimbursement Form

To receive a reimbursement for your Clay or Circle Grant program, complete this form and attach PDF copies of receipts for actual expenses accrued. If you have any questions about the reimbursement process, contact Jamie Bouldin (jamie@odk.org | 540-458-5348). DEADLINE FOR REIMBURSEMENTS: November 30, 2023

Institution and Circle Name (if designated) *

Select Grant Type

Clay Leadership Development Grant

Diversity, Equity, and Inclusion Grant

Endowed Circle Grant

First Name *

Last Name *

Email Address *

Reimbursement Amount Requested *

Please note: Grants are awarded for actual expenses up to the amount offered in the grant paperwork, with a limit of $1,000. Your submitted receipts should add up to the total amount requested for reimbursement.

Make the Check Payable to: *

Please insert the specific name of the institution or individual to whom the payment should be addressed. If this is a circle private bank account, it is helpful if you attach a voided check or deposit ticket so we can include that account number on the check.

Send check "Attention To": *

Mailing Address for Payment *

Please make sure that any office numbers or campus PO boxes are included if necessary for efficient receipt of payment.

Apt, suite, etc.

Country

City

State

Zip code

Program Title *

Program Date *

Program Brief *

Program Report *

In 1000 words or less, provide a detailed description of the activities and outcome of the final program. These reports may be used for ODK publications so please be as detailed as possible. If you have photos of your program, please send directly to Jamie Bouldin, jamie@odk.org.

Other Information

Receipt Attachments *

Combine and attach PDF copies of all receipts related to your program. The total amount of these receipts should equal your request. This form only allows one upload of receipts.

Photographs

Please upload a photo from your event. You may also email programs@odk.org with additional photos, or email a link to an online shared drive with photos to download.

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