Teacher Reimbursement Form

If you are requesting that the HSA reimburse you for incurred expenses, you must complete this form and attach receipts/invoices.

NO SALES TAX CAN BE REIMBURSED BY THE HSA. Please give vendors the HSA's tax-exempt certificate available here.

If you are requesting that the HSA pay a vendor or reimburse you for incurred expenses, you must complete this form and attach receipts/invoices.

NO SALES TAX CAN BE REIMBURSED BY THE HSA. Please give vendors the HSA's tax-exempt certificate: 

Tax Exempt Certificate

Instructions: 

1. Receipts/Invoices must show date incurred, amount of expense and items purchased


2. A receipt of your submitted request will be emailed to you (keep for your records).

If you a question about your budget, please reach out to Maugham School HSA at maughamschoolhsa@gmail.com.

All reimbursements will be sent by check in the mail in approximately 7 days from processing.