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Fiscal Year 201516Special Education GrantEXPENDITURE DEPARTMENTAL HEALTH AVERAGE DAILY ATTENDANCE (ADA) ALLOCATION (Refer to AO400 to complete)Grantee Name and Address:SELMA Code and SELMA Name:Grant
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What is *See reverse for reimbursement and Report 4 Budget Plan requirements Form?

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See reverse for reimbursement is a form used to request repayment or compensation for expenses incurred.
Any individual or organization seeking reimbursement for expenses is required to file see reverse for reimbursement.
To fill out see reverse for reimbursement, provide detailed information about the expenses incurred, including dates, amounts, and purposes.
The purpose of see reverse for reimbursement is to ensure that individuals or organizations are reimbursed for legitimate expenses incurred.
Information such as the incurred expenses, dates, purposes, and supporting documentation must be reported on see reverse for reimbursement.
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