VIRGINIA CHAPTER
Kairos Prison Ministry International, Inc.
Classified by IRS as a 501 C (3) Corporation (FIN 59-1970458)
Website: www.kairosva.org Email:
EXPENSE REIMBURSEMENT FORM
Date: ______
Name: ______Correctional Center ______Weekend # _____
Address: ______
City: ______State: ______Zip Code: ______Phone: ______- ______- ______
Reimbursement is hereby requested for the following expenses, as supported by receipts:
Program Weekend Expenses:
Agape Supplies $ ______
Badges (Name Tags) $ ______
Computer & Equipment $ ______
Decorations $ ______
Equipment Rental $ ______
EZRA $ ______
Flowers $ ______
Housing / Facility Rent $ ______
Meals (Food) $ ______
Music Royalty Fee (CCLI License) $ ______
Pictures $ ______
Postage & Shipping $ ______
Printing / Copies $ ______
Program Materials $ ______
Supplies / Paper Products $ ______
Other Expenses $ ______
Post Weekend Expenses:
One or Two Day Retreats $ ______
Prisoner to Prisoner (P2P) $ ______
Reunion Expenses $ ______
Other Expenses:
Bibles $ ______
Greeting Cards $ ______
Team Meeting Supplies $ ______
TOTAL $ ______
Signed: ______
Advisory Council Donor Coordinator approval (required): ______
COMPLETE ONE SHEET FOR EACH VOLUNTEER
ATTACH RECEIPTS & / or OTHER TYPES OF DOCUMENTATION:
Mail to: Carl Wright, Financial Secretary
P.O. Box 21336
Roanoke, Va.24018
Phone 540-529-3891
Or email PDF to: Form Revised 7/1/2013
Policy on Processing Expense Reimbursement Forms
All requests from Kairos volunteers for Expense Reimbursements, Vendor payments or Supply Orders must be sent to the Advisory Council Donor Coordinator for their written approval, then forwarded to the State Financial Secretary for processing. The AC Donor Coordinators will keep copies of all expense forms to enable them to verify the amounts charged to their Advisory Council on periodic financial reports distributed by the state Financial Secretary.
Program Manuals, Crosses, Freedom Guides, Grouping Cards, Dissolvable paper, Songbooks, and Three Legged Stools are all ordered from KPMI, Inc. on a KPMI Supply Order Form found on the kairosva.org website.