Form SFN 58965 Expense Claim for Substitute Teacher - North Dakota

Form SFN58965 or the "Expense Claim For Substitute Teacher" is a form issued by the North Dakota Department of Public Instruction.

Download a PDF version of the Form SFN58965 down below or find it on the North Dakota Department of Public Instruction Forms website.

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EXPENSE CLAIM FOR SUBSTITUTE TEACHER
NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION
OFFICE OF FISCAL MANAGEMENT
SFN 58965 (Rev. 8-2016)
I. School Information
School District
Mailing Address
City
State
ZIP Code
II. Meeting Information
Title of meeting attended
Meeting Date
Meeting location
Department of Public Instruction Unit sponsoring meeting
III. Teacher Information
(attach additional pages if needed)
Name of teacher needing substitute
Number of days to be reimbursed
Name of teacher needing substitute
Number of days to be reimbursed
Name of teacher needing substitute
Number of days to be reimbursed
IV. Amount of Request
Total number of Days to be Reimbursed
x Daily Rate of $
= $
(daily rate not to exceed $110 per day)
Certification: I certify that this statement truthfully and accurately describes the services rendered, and that the amount of payment will not be
Duplicated from any other source.
Signature of Authorized Representative
Date
For Department Use Only:
Contract
Speed Chart
Year
Class
Dept. ID
Fund
Project
Activity
Account
Category
20130
Unit Approval
Date
Grant Mgr.
Date
Submit to:
ND Dept of Public Instruction
Office of Fiscal Management
600 E Boulevard Ave, Dept 201
Bismarck, ND 58505-0440
EXPENSE CLAIM FOR SUBSTITUTE TEACHER
NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION
OFFICE OF FISCAL MANAGEMENT
SFN 58965 (Rev. 8-2016)
I. School Information
School District
Mailing Address
City
State
ZIP Code
II. Meeting Information
Title of meeting attended
Meeting Date
Meeting location
Department of Public Instruction Unit sponsoring meeting
III. Teacher Information
(attach additional pages if needed)
Name of teacher needing substitute
Number of days to be reimbursed
Name of teacher needing substitute
Number of days to be reimbursed
Name of teacher needing substitute
Number of days to be reimbursed
IV. Amount of Request
Total number of Days to be Reimbursed
x Daily Rate of $
= $
(daily rate not to exceed $110 per day)
Certification: I certify that this statement truthfully and accurately describes the services rendered, and that the amount of payment will not be
Duplicated from any other source.
Signature of Authorized Representative
Date
For Department Use Only:
Contract
Speed Chart
Year
Class
Dept. ID
Fund
Project
Activity
Account
Category
20130
Unit Approval
Date
Grant Mgr.
Date
Submit to:
ND Dept of Public Instruction
Office of Fiscal Management
600 E Boulevard Ave, Dept 201
Bismarck, ND 58505-0440

Download Form SFN 58965 Expense Claim for Substitute Teacher - North Dakota

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