Parent Education Presenters Invoice
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Parent Education Presenters Invoice Form. This is a West Virginia form and can be use in Parent Education Supreme Court Of Appeals.
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Tags: Parent Education Presenters Invoice, West Virginia Supreme Court Of Appeals, Parent Education
County:
PARENT EDUCATION PRESENTER INVOICE
(To be paid through Parent Education and Mediation Fund 1759)
Submit completed form to:
Pepper Flenner
WV Supreme Court of Appeals
1900 Kanawha Blvd.
Building 1, Room E-100
Charleston, WV 25305
Invoice Number:
Presenter:
Make check payable to:
Social Security or FEIN:
Address for remittance:
Phone (home):
Fax:
Phone (work):
E-mail:
Class Information: (ONE class session per presenter, per invoice)
Date:
County:
Number:
waived
Total Number of Parents who attended the class on this date:
Solo-presenter -ORCo-presenter
* Please check appropriate box below:
Bachelor's Degree
($100.00 per session)
Master's Degree
($115.00 per session)
Doctoral Degree
($130.00 per session)
Total Session
* Out-of-County Mileage (available only if traveling to present class outside of home county)
Home
Round Trip miles traveled:
X
7-12/2011 Mileage Rate = $0.555/mile
1-6/2011 Mileage Rate = $0.51/ mile
Total Mileage:
* Out-of-Pocket Fees (a receipt must be attached to receive reimbursement)
Amount due:
Description:
Out-of-Pocket Fees:
Add session fees, mileage, and out-of-pocket fees:
Total Due:
Presenter's Signature: ________________________________
(Must be in blue ink)
Date: ________________________________
Administrative Office use only:
Approved: __________________________________________
FPEPINV Rev. 07/2011 (previously SCA-FC-PE-604)
Parent Education Presenter's Invoice
Date: ________________________________
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