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Program Expense Tracking Form
Please complete this form with every purchase
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* Indicates required question
Employee Name
*
Your answer
Date of Purchase
*
MM
/
DD
/
YYYY
Place of Purchase
*
Your answer
What was purchased?
*
Your answer
Select the classification of the purchase.
Personal Care (Hair care; upon request)
Clothing (Ex: Pre-approval required by R.M.)
Meals (Ex: Out to eat meals - should be on an as-needed basis)
Fuel (Ex: Gas)
Medical (Ex: Prescriptions, co-pays *OTC meds & vitamins require pre-approval*)
Household (Ex: Cleaning supplies, laundry, dishwasher, batteries, paper goods, etc.)
General Supplies (Always requires approval from PD. Materials for groups, books/workbooks, craft supplies, therapy/anxiety toys, equipment)
Entertainment (Ex: planned weekend outings- $15 per resident and staff member per outing)
Groceries (Budgeted for $75 per resident + 2 staff per week)
Parking (parking garages or parking lots)
Vehicle Rental & Maintenance (Ex: Needs approval on purchases over $250- Oil changes, parts replacements, registration, EZ tag/tolls.)
Office Supplies (Ex: Ink, pens, markers, tape, laminating paper, magnet boards, etc.)
Postage & Shipping (Program-related correspondence only, not to be used for residents)
Printing & Copying (Paper from Costco)
Legal (Pre-approval required by P.D.)
Was this purchased for a resident? If so, please write the resident number.
Your answer
Amount Spent
*
Your answer
Has the receipt been sent to Accounting and Program Coordinator?
*
Yes
No
If you do not have a receipt, please explain why.
Your answer
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