EANS I Reimbursement Invoice

* required field

Contact Information

School Name *

Authorized Representative of the School *

Email *

Total Reimbursement

Reimbursement Amount *

Arizona EANS I Invoice with Proof of Payment(s) *

Please submit the reimbursement invoice form along with all proofs of payment for reimbursement requests. Documents must be submitted as a single PDF. Please do not lock the document when signing, in order to allow further signatures and edits. The invoice form can be found here: https://www.azed.gov/sites/default/files/2022/01/AZ%20EANS%20I%20Reimbursement%20Invoice%20Template-%20With%20Internal%20Labels.pdf

Resubmission Status

Please indicate if this is a new request or a resubmitted request with corrections. Include the file name sent from ADE if sending a resubmission.

Resubmission? *

Leave this field blank