2024 Dairy Promotion Grant Reimbursement Form

1. Main Contact Information *This question is required.

First Name

Last Name

Email Address

Phone Number

2. Name of Event *This question is required.

3. Grant Number *This question is required.

4. Event Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

5. City of Event *This question is required.

6. Please list the dairy products distributed and their associated cost.
(If no dairy items are requested for reimbursement, please put none) *This question is required.

7. Please list the NON-DAIRY items distributed and their associated cost.
(If no non-dairy items are requested for reimbursement, please put none) *This question is required.

8. Was this grant used to purchase chocolate milk for school athletes? *This question is required.

What size were the units that were purchased? *This question is required.

How many total units were purchased? *This question is required.

9. Total amount submitting for reimbursement *This question is required. This question requires a valid currency format.

10. Please attach itemized receipt or paid invoice. *This question is required.

File: {{filename}} delete

11. Make Check Payable To *This question is required.

12. Street name *This question is required.

13. City *This question is required.

14. State *This question is required.

15. Zip *This question is required.