Verify Your Reimbursement 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 InformationName of School District or School*Please Select Your School21st Century Public AcademyAcademy for Technology and the ClassicsAce LeadershipACES Technical High SchoolActon Academy AlbuquerqueActon Academy Mesilla ValleyActs Christian AcademyAdventist Academy of Santa FeAlamo Navajo Community SchoolAlamo Navajo School BoardAlamogordo Public SchoolsAlbuquerque AcademyAlbuquerque Bilingual AcademyAlbuquerque Charter AcademyAlbuquerque Christian SchoolAlbuquerque Collegiate CharterAlbuquerque Country Day SchoolAlbuquerque Institute of Mathematics and Science (AIMS)Albuquerque Public SchoolsAlbuquerque School of ExcellenceAlbuquerque Talent Development AcademyAldo Leopold High SchoolAlice King Community SchoolAll Saints Catholic SchoolAll Seasons Day SchoolAlma d' arte Charter High SchoolAltura Preparatory SchoolAlvarado Day SchoolAmy Biehl Charter High SchoolAnansi Charter SchoolAnimas Public SchoolsAnnunciation Catholic SchoolApostolic Praise Christian AcademyApple Tree Educational CenterapArtesia Public SchoolsAtsá Biyáázh Community SchoolAztec Municipal SchoolsBaca /Dlo'Ay Azhi Community SchoolBeclabito Day SchoolBelen Consolidated SchoolsBernalillo Public SchoolsBloomfield SchoolsBlue Bird Day Care and Learning CenterBosque Farms Christian AcademyBosque SchoolBread Springs Day SchoolCalvary Christian AcademyCalvary Christian AcademyCalvary West Christian SchoolCanon Christian AcademyCanyon Christian AcademyCanyoncito Montessori SchoolCapitan Municipal SchoolsCarlsbad Municipal SchoolsCarrizozo Municipal SchoolsCatholic Charities Children's Learning CenterCentral Consolidated SchoolsCesar Chavez Community SchoolCh'ooshgai Community SchoolChama Valley SchoolsChi Chil'tah Community SchoolChildco Day SchoolChrist Lutheran SchoolChristine Duncan’s Heritage AcademyCien Aguas International SchoolCimarron Public SchoolsClayton Municipal SchoolsCloudcroft Municipal SchoolsClovis Christian SchoolsClovis Municipal SchoolsCobre Consolidated SchoolsCoral Community Charter SchoolCornerstone Christian AcademyCorona Public SchoolsCoronado Children's CenterCorrales International SchoolCottonwood Classical Preparatory School (CCPS)Cottonwood Montessori SchoolCottonwood Valley Charter SchoolCovenant School Del NorteCovenant Schools of Rio RanchoCrestview Seventh-day Adventist AcademyCross of Hope SchoolCrystal Boarding SchoolCuba Independent SchoolsDel Rio AcademyDeming Cesar Chavez Charter High SchoolDeming Public SchoolsDes Moines Municipal SchoolsDesert Montessori SchoolDexter Consolidated SchoolsDibe Yazhi Habitiin Olta, Inc (Borrego Pass)Digital Arts and Technology AcademyDiscover Christian SchoolDora Consolidated SchoolsDream Diné Charter SchoolDulce Independent SchoolsDzilth-Na-O-Dith-Hle Community SchoolDzit Dit Lool School of Empowerment, Action and Perseverance (DEAP)East Mountain High SchoolEastern Hills Christian AcademyEdgewood Christian SchoolEl Camino Real AcademyElida Municipal SchoolsEscuela Del Sol MontessoriEspañola Public SchoolsEstancia Municipal SchoolsEstancia Valley Classical AcademyEunice Holiness AcademyEunice Public SchoolsEvangel Christian AcademyExplore AcademyExplore Academy - Las CrucesFarmington Municipal SchoolsFayette Street AcademyFloyd Municipal SchoolsFort Sumner Municipal SchoolsGadsden Independent SchoolsGallup Christian SchoolGallup-McKinley County SchoolsGateway Christian SchoolGilbert L. Sena Charter High SchoolGordon Bernell Charter SchoolGospel Light Baptist AcademyGrace Baptist AcademyGraceway Christian AcademyGrady Municipal SchoolsGrants-Cibola County SchoolsGuadalupe Montessori SchoolHaak'u Community AcademyHagerman Municipal SchoolsHatch Valley Public SchoolsHealth Leadership High SchoolHilltop Christian SchoolHobbs Municipal SchoolsHoly Child Catholic SchoolHoly Cross Catholic SchoolHoly GhostHondo Valley Public SchoolsHope Christian SchoolHorizon Academy WestHouse Municipal SchoolsHozho AcademyImago Dei AcademyImmanuel Lutheran School - AlbuquerqueImmanuel Lutheran School -RoswellInternational School at Mesa del SolIsleta Elementary SchoolJ. Paul Taylor AcademyJal Public SchoolsJefferson Montessori AcademyJemez Day SchoolJemez Mountain Public SchoolsJemez Valley Public SchoolsJourney Montessori SchoolJunction Christian AcademyKeres Children's Learning CenterKha'p'o Community SchoolKids Under ConstructionKinteel Residential Campus, Inc.La Academia de Esperanza Charter SchoolLa Academia Dolores HuertaLa Mariposa Montessori SchoolLa Resolana Leadership AcademyLa Tierra Montessori School of the Arts and SciencesLa Vida Mission SchoolLaguna Acoma Junior and Senior High SchoolLaguna Elementary SchoolLaguna Middle SchoolLake Arthur Municipal SchoolsLake Valley Navajo SchoolLas Cruces AcademyLas Cruces Catholic SchoolLas Cruces Public SchoolsLas Cruces SDA AcademyLas Montañas Charter SchoolLas Vegas City Public SchoolsLegacy AcademyLegacy Christian AcademyLiberty Ranch SchoolLittle Corral Day SchoolLittle Earth SchoolLittle Learners Play School, Inc.Living Word Christian AcademyLogan Municipal SchoolsLordsburg Municipal SchoolsLos Alamos Public SchoolsLos Lunas Public SchoolsLos Puentes Charter SchoolLoving Municipal SchoolsLovington Public SchoolsMaddy-Tay's Wonderful World of ChildrenMagdalena Municipal SchoolsManzano Christian SchoolManzano Day SchoolMariano Lake Community SchoolMark Armijo Academy (formerly Nuestros Valores)Maxwell Municipal SchoolsMay Center for LearningMcCurdy Charter SchoolMcCurdy SchoolMedia Arts Collaborative Charter School (MACCS)Melrose Public SchoolsMenaul School - AlbuquerqueMesa Vista Consolidated SchoolsMescalero Apache SchoolMesilla Valley Christian SchoolMiddle College High School - GALMission Achievement and Success Charter School (MAS)Mission Lutheran SchoolMonte del Sol Charter SchoolMontessori Elementary & Middle SchoolMontessori of the Rio Grande CharterMontessori ONE AcademyMora Independent SchoolsMoreno Valley High SchoolMoriarty-Edgewood School DistrictMosaic Academy CharterMosquero Municipal SchoolsMountain Mahogany Community SchoolMountain View Private SchoolMountainair Public SchoolsNa'Neelzhiin Ji'Olta (Torreon)Native American Community Academy (NACA)Navajo Preparatory SchoolNenahnezad Community SchoolNew America School of Las CrucesNew America School-New MexicoNew Beginnings Christian AcademyNew Mexico Connections AcademyNew Mexico International SchoolNew Mexico School for the ArtsNew Mexico School for the Blind and Visually ImpairedNew Mexico School for the DeafNew Sunrise Regional Treatment CenterNoah's Ark Children's AcademyNoah's Ark Children's AcademyNoah's Ark Children's AcademyNoah's Ark Christian Preschool & KindergartenNorth Valley Academy Charter SchoolOak Grove Classical AcademyOhkay Owingeh Community SchoolOjo Encino Day SchoolOur Lady of Fatima Catholic SchoolOur Lady of the Assumption Catholic SchoolOur Place For LearningParadise Christian SchoolPathways AcademyPecos Independent SchoolsPeñasco Independent SchoolsPine Hill SchoolsPojoaque Valley Public SchoolsPonderosa Montessori SchoolPortales Municipal SchoolsPrince of Peace Lutheran SchoolPublic Academy for Performing ArtsPueblo of Isleta Elementary SchoolPueblo Pintado Community SchoolQuemado Independent SchoolsQuesta Independent SchoolsRaices del Saber Xinachtli Community SchoolRaton Public SchoolsRed River Valley Charter SchoolRehoboth Christian SchoolReserve Independent SchoolsRio Gallinas School for Ecology and the ArtsRio Grande Christian AcademyRio Grande SchoolRio Rancho Public SchoolsRobert F. Kennedy Charter SchoolRock Christian AcademyRoots and Wings Community SchoolRoswell Independent SchoolsRoy Municipal SchoolsRuidoso Municipal SchoolsSacred Heart Catholic School - FarmingtonSacred Heart Catholic School - GallupSalam AcademySan Diego Riverside Charter SchoolSan Felipe de Neri SchoolSan Felipe Pueblo Elementary SchoolSan Ildefonso Day SchoolSan Jon Municipal SchoolsSandia Montessori School of Albuquerque, Inc.Sandia Preparatory SchoolSandia View AcademySandia View Christian SchoolSandoval Academy of Bilingual Education (SABE)Sanostee Day SchoolSanta Fe Girl's SchoolSanta Fe Indian SchoolSanta Fe Preparatory SchoolSanta Fe Public SchoolsSanta Fe School for the Arts and SciencesSanta Fe Waldorf SchoolSanta Rosa Consolidated SchoolsSanto Nino Regional Catholic SchoolSchool of Dreams Academy (SODA)Shandiin Child Development CenterShepard Lutheran SchoolShiprock Northwest High SchoolSidney Gutierrez Middle SchoolSiembra Leadership High SchoolSilver Consolidated SchoolsSix Directions Indigenous Charter SchoolSocorro Consolidated SchoolsSolare Collegiate Charter SchoolSouth Valley AcademySouth Valley Preparatory SchoolSouthwest Aeronautics, Mathematics, and Science Academy (SAMS)Southwest Preparatory Learning CenterSouthwest Secondary Learning CenterSpringer Municipal SchoolsSpringStone Montessori SchoolSpringstone Montessori SchoolSpringStone Montessori School - GrandeSpringStone Randolph Montessori SchoolSt. Anthony Indian SchoolSt. Bonaventure Indian SchoolSt. Charles Borromeo SchoolSt. Francis Cabrini Catholic SchoolSt. Francis of AssisiSt. Helena Catholic SchoolSt. Joseph Mission SchoolSt. Mary's Catholic SchoolSt. Mary's SchoolSt. Michael's High SchoolSt. Pius X High SchoolSt. Teresa of Avila Catholic SchoolSt. Therese Catholic SchoolSt. Thomas Aquinas Catholic SchoolSunset Mesa SchoolT'iis Ts'ozi Bi'Olta' (Crownpoint Community School)T'siya Day SchoolTaos AcademyTaos Day SchoolTaos Integrated School of the ArtsTaos International Charter SchoolTaos Municipal Charter SchoolTaos Municipal SchoolsTatum Municipal SchoolsTe Tsu Geh Oweenge Day SchoolTechnology Leadership High SchoolTemple Baptist AcademyTexico Municipal SchoolsThe Albuquerque Sign Language AcademyThe ASK AcademyThe Children's GardenThe Children's Garden Child Development CenterThe Children's Garden Child Development CenterThe Children's Garden On CourtThe Children's Garden on MissouriThe Great AcademyThe MASTERS Program Early College Charter SchoolTierra Adentro: The NM School of Academics, Art and ArtesaniaTierra Encantada Charter SchoolTohaali Community SchoolTóHajiilee Community SchoolTruth or Consequences Municipal SchoolsTse'ii'ahi' Community SchoolTucumcari Public SchoolsTularosa Municipal SchoolsTurquoise Trail Charter SchoolUWC-USAVaughn Municipal SchoolsVeritas Classical Christian AcademyVictory Christian AcademyVilla Santa Maria SchoolVista Grande Charter High SchoolVoz Collegiate Preparatory Charter SchoolWagon Mound Public SchoolsWalatowa High Charter SchoolWest Las Vegas Public SchoolsWestern Heights Learning CenterWildcat Christian AcademyWilliam W. & Josephine Dorn Charter Community SchoolWingate Elementary SchoolWingate High SchoolZuni Christian Mission SchoolZuni Public Schools 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 RequestStaffing - Full-Time and Part-Time Funding Request AmountStaffing - 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* MM slash DD slash YYYY Signature*