Chapter Education Grant (CEG) Reimbursement Request Please note that this form needs to be completed by a member of the chapter/associate chapter Board of Governors (BOG). OK Question Title * 1. BOG Member Contact Information: Name * Position on BOG Email Address * Phone Number * OK Question Title * 2. Chapter: OK Question Title * 3. College/University Name: OK Question Title * 4. Grant Request Purpose: Leadership Academy Sponsorship Regional Conference Sponsorship Zenith Officer Institute Building Men of Character Retreat Sponsorship UIFI Sponsorship Chapter Facility Sponsorship Local Academic Scholarship Other Outside Leadership Program Other Phi Kappa Tau Leadership Program Other (please specify) OK Question Title * 5. Date of Event: Date / Time Date OK Question Title * 6. Receipts for educational materials: You are limited to 5 documents. Please combine multiple receipts into a single document. You must upload your documents in PDF, JPG or PNG formats. List Check Payable Legal Name of each recipient here & amount. If Multiple grants to be given - list all here with corresponding amount. PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File You are limited to 5 documents. Please combine multiple receipts into a single document. You must upload your documents in PDF, JPG or PNG formats. List Check Payable Legal Name of each recipient here & amount. If Multiple grants to be given - list all here with corresponding amount. OK Question Title * 7. Further explanation of grant request purpose, if necessary: OK Question Title * 8. Officer/Recipient Contact Information (If multiple recipients please list one mailing address) : Name Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number OK Question Title * 9. Officer Title if applicable: OK Question Title * 10. Requested Amount per person OK DONE