Reimbursement Submission - NM Schools COVID Testing

Expense Report/Reimbursement Request Submission

Please verify the following information to finalize your reimbursement request and/or report. We will not review any of the documents in the share link until you have submitted this form. Click "Next" to begin.

Verify Contact and Mailing Information

Name of School District or School*

Contact Name*

First Last

Contact Phone*

Contact Email*

Enter Email Confirm Email

Mailing Address*

Let us know where we should send the reimbursement check.

Street Address Address Line 2 City ZIP Code

How are COVID-19 tests for your students and staff being conducted? Select all that apply.*

Full-Service Vendor or Third Party Organization

School Staff

Other (please describe)

If you selected "Other" , please describe below.

While the direct purpose of this funding is to support COVID-19 prevention, mitigation, and response, it does support school health services overall. How much did you consider the sustainability of your programming in using this funding?*

I did not consider sustainability at all

I somewhat considered sustainability

I very much considered sustainability

Please share with us any recommendations you have for our program.

Verify Total Reimbursement Request

Staffing - Full-Time and Part-Time Funding Request Amount

Staffing - Staff Time Funding Request Amount

Supplies - Community Outreach and Coordination Funding Request Amount

Supplies - COVID-19 Data Documentation and Storage Funding Request Amount

Supplies - Other Funding Request Amount

Services - Licenses and Fees Funding Request Amount

Capital Improvement Funding Request Amount

Other Expenses - Funding Request Amount

Total Requested (this will autocalculate)

As of April 15, 2022, we will not send additional funds to your school/district if you have not reported on all the advance funding you received.

Please indicate your preferences for reimbursement.*

I am reporting on expenses made through my advance (no reimbursement requested).

I would like to request a partial reimbursement.

I would like a full reimbursement.

Please indicate the amount you would like to receive as a partial reimbursement.

Please share anything else related to your testing program.

Name*

First Last

Date*

Signature*

Verify Your Reimbursement

Expense Report/Reimbursement Request Submission

Verify Contact and Mailing Information

Verify Total Reimbursement Request