"*" indicates required fields Disbursement RequestFields marked with an * are required.Reimbursement Request DetailsRequest Date: 08/17/2026Reason for Disbursement*SelectConferenceOtherConference*SelectPresidents Conference — Jul 30–Aug 2, 2026Special Education Conference — Oct 2–4, 2026State Council of Education — Oct 23–25, 2026LGBTQ+ Issues Conference — Nov 6–8, 2026CTA Organizing Academy — Jan 15–17, 2027State Council of Education — Jan 29–31, 2027New Educator Weekend South — Feb 19–21, 2027Equity & Human Rights Conference — Mar 5–7, 2027Good Teaching Conference (South) — Mar 12–14, 2027State Council of Education — Apr 2–4, 2027Women's Leadership Conference — Apr 16–18, 2027State Council of Education — Jun 4–6, 2027Summer Institute — Jul 11–15, 2027Presidents Conference — Jul 22–25, 2027Other ConferenceDescription*Conference Start Date* Conference End Date* Date* Name* First Last Email* Phone*Expenses Mileage is reimbursed at the current IRS rate of 76¢ per mile. Select Mileage as the category and enter the number of miles — the amount will calculate automatically at 76¢ per mile.For the mileage receipt, please provide a map showing the mileage to and from your destination. Travel is reimbursed at the least expensive option (airfare, train, mileage, etc.) unless another option is pre-approved. Meals are reimbursed up to a maximum of $90 per day, including beverages and tips. Portage is reimbursed up to $8 per day. (No receipt required for portage.)If you do not have a receipt for a line, use that line’s No Receipt button to explain why. Please itemize each expense below and attach a receipt for each line.Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Date* Check Out* Category*SelectAirfareTransportationParking/TollsLodgingBreakfastLunchDinnerPortageMileageOtherDescriptionNumber of Miles*Amount*AmountReceipt Drop files here or Select files Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10. Additional Lines+ Add line− Remove lineTotal Disbursement AmountReimbursement MethodHow would you like to be reimbursed?*SelectMail CheckPickup Check at NOCUT OfficeReceive ZelleName on Check*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name on Zelle Account*Provide the email and/or phone number associated with your Zelle account below. If you are not sure which one you registered, provide both.Zelle Email Address Zelle Phone NumberPlease pick up your check at the NOCUT office at 749 South Brea Blvd, Suite 42, Brea, CA 92821 between the hours of 8:30–4:30 Monday through Thursday and 8:30–3:30 on Fridays. You will be notified when your check is ready to be picked up.CAPTCHA*All information will be verified by the association President and Treasurer prior to issuing a reimbursement.
