Complete the following parts of the form as follows:

1. The applicant agency or governmental unit as it appears on the agreement to whom the reimbursement check will be issued, date that the claim was prepared, who prepared the claim, a telephone number for the person that prepared the claim, name of the course that was taught through the grant, date of the course as submitted in your grant application, actual course date (if applicable).
2. Summarize actual costs by category as established in the original grant agreement.
3. The Project Director and Authorizing Official must sign this document in ink. Do not use a signature stamp.

Also, submit the following:

1. A roster of students attending and identifying students from targeted departments. Identify if targeting was from IDOT Alcohol Over-rep data, ILETSB survey or ICC 9-1-1 data.
2. Receipts for all expenses shall be provided with the claim.

NOTE: Please submit your claim and all required documents to the Board no later than 30 days after the course was held. Claims received after the thirty days may not be authorized for reimbursement.

Forms Available for Download

Police Traffic Services Training Project - Request and Agreement Form

Supply Requisition Form - Illinois Emergency Mangement Agency (IEMA)

Claim for Reimbursement - IDOT Grant

Sample Evaluation Form H