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.

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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. Describe the audience you reached (i.e. moms, children, seniors, runners, etc.): *This question is required.

9. How many people did your promotion reach (approximately)? *This question is required.

10. What was the best comment you received from a participant at the event? *This question is required.

11. 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.

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

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

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14. Please upload any photos from the event you would like to share.

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

16. Street name *This question is required.

17. City *This question is required.

18. State *This question is required.

19. Zip *This question is required.