|Literacy Grants Application - Literacy Grant Disbursements Request|
REQUEST FOR LITERACY GRANT AWARD DISBURSEMENT
City, State, Zip: ______________________________________________________________________
Contact Phone Number: ___________________________
Your Literacy Grant Award may be requested in one or multiple disbursements.
Indicate the amount requested for purchase or reimbursement in the table below.
Attach copy of your purchase order or invoice. If necessary, indicate which item(s) on the document is associated with your Literacy Project and represents the total of your request.
Forward this Disbursement Request and attachments to:
PO Box 4164
Oak Ridge, TN 37831-4164
Checks will be made to your organization and returned to your address on our records. Please use the space provided to make corrections or changes.
Allow 2–3 weeks to process your check request. If your check is not received in 30 days, please contact the ORBRC Foundation Treasurer at 865-483-9272 or email@example.com.
|FOR FOUNDATION REPLY|
|DATE||AMOUNT||CHECK NUMBER||GRANT BALANCE|
ALL DISBURSEMENT REQUESTS RELATED TO 2015 GRANTS MUST BE RECEIVED BY
DECEMBER 31, 2015