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| Please fill out your reimbursement forms and submit them to finance@reliant.org on a monthly basis. If you have multiple service providers in a given month, please fill out one reimbursement form for the entire month for each provider, and attach all receipts for the amounts paid to that provider within the month. For example, if you have 2 babysitters that you paid weekly, you can either create one receipt for all the weekly payments for each babysitter to sign (so you create a monthly summary receipt for the babysitters to sign) or attach a receipt for each weekly amount paid to the babysitters within the month. Then you would fill out one reimbursement form for each babysitter for the month. |
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- The top portion of the form: Name, FD#, address, etc.
- Amount of reimbursement: enter the full amount of the child care paid for dates of service
- Dates of service: Enter starting and ending dates (we ask that the form be for only one month of service, same as for reimbursements)
- Place Type of Service Provided: Name of the child care facilityProvider: Select either Individual or Business
- Service Provider Name: Name of individual or business providing the child care
- Service Provider Address/Phone
- Service Provider SSN# or Employer ID: If you selected "Business" as the type of provider, this will be the business employer ID # if a child care facility is providing the service (we no longer require the social security # of the individual providing child care services)#
- Check the boxes that apply (per instructions on the form)
- Sign the form and print/scan or type your name
- Use the Receipt tab to include a scan or photo of your child care expense receipt
- Share the form with Email to finance@reliant.org (using your reliant.org email address) and attach your receipt . If you haven't added the receipt to the Receipt tab, email the scan(s) as attachments to finance@reliant.org.
