Culinary Kit Reimbursement Form

Culinary Kit Grocery Reimbursement Form
Culinary Kit Grocery Reimbursement Instructions
This form accepts reimbursement requests with receipts submitted before June 19, 2026, or until grant funds are exhausted.

Reimbursements are approved at BHSSC board meetings, held on the fourth Wednesday of each month. Check payments will be mailed in the days following the next monthly board meeting.

Submission Guidelines
- 1 submission per lesson
- Upload legible receipts (scanned or photo format)
- Receipts must only include purchased grocery items purchased for the selected Culinary Kit lesson - no personal items allowed
Project
Date(s) of Project
Coordinator
Code To
Email to receive Final PDF-post approval
example@example.com
Select your school type and school.*
How many students participated in this Culinary Kit lesson?*
Which grade band is associated with this reimbursement?*

K-12-34-5
Which K-1 lesson is this reimbursement connected to?*

All About BerriesCucumber ExplorationEat Your Peas, LouiseThat Fruit is MineThis Watermelon is Not Round
Which 2-3 lesson is this reimbursement connected to?*

A Fruit is a Suitcase for SeedsAnansi and the Talking MelonCreepy CarrotsKatie’s CabbageRuby Plants A Radish
Which 4-5 lesson is this reimbursement connected to?*

Amazing ApplesCrazy About CornLovely LettucePumpkin PizzazzSpectacular Spinach
Number of receipts submitting for reimbursement*
Receipt 1 Date*

MonthDayYear
Date
Receipt 1 Amount*
Description1
Receipt 2 Date*

MonthDayYear
Date
Receipt 2 Amount*
Description2
Receipt 3 Date*

MonthDayYear
Date
Receipt 3 Amount*
Description3
Receipt Calculation
Upload itemized receipt(s)*

Cancelof
Total Reimbursement (Auto Calculated)

Culinary Kit Grocery Reimbursement Form

Claimant Information