NEF Disbursement Form – NON-PERSONNEL | Northampton Education Foundation

Disbursement Form - Non-Personnel

This form may be used to request direct payment to a third party or to request reimbursement for approved expenses (include invoices, receipts and requisitions).

Name of Project*
Project ID#*
Lead Grantee*
First Last
Email*
A. Consultant Fees
Please attach invoice and submit a completed I.R.S. Form W-9. Please do not upload W-9s containing Social Security Numbers or send them via email, since it is a significant security risk. Send them by U.S. mail to NEF at P.O. Box 44, Northampton, MA 01061, attn: Grant Administrator or contact Megan Zinn at mrzinn88@gmail.com arrange a handoff. W-9s with Employer Identification Numbers (EIN) rather than SSN are safe to upload or email, as EINs are public information.
Name - (1)
# of Days - (1)
Rate/Day - (1)
Cost (1)
Price: $0.00
Name - (2)
# of Days - (2)
Rate/Day - (2)
Cost (2)
Price: $0.00
Name - (3)
# of Days - (3)
Rate/Day - (3)
Cost (3)
Price: $0.00
Name - (4)
# of Days - (4)
Rate/Day - (4)
Cost (4)
Price: $0.00
Name - (5)
# of Days - (5)
Rate/Day - (5)
Cost (5)
Price: $0.00
Any additional Names to add?
Please list additional names and cost
Name x Hours x Total Cost
Total Additional Cost
Total Consultant Cost
Automatically Calculated
Please attach invoice and submit a completed I.R.S. Form W-9.
Drop files here or

Max. file size: 256 MB.
B. Transportation Costs
Describe and list costs
Total Transportation Cost
Please attach invoice or School Department requisition form.
Drop files here or

Max. file size: 256 MB.
C. Supplies
(Subscriptions, materials, book, etc.)
List Supplies & Cost
List each item, cost, and the supplier, if known. Please attach original invoice if payment is to be made directly, or receipts if request is for reimbursement.
Total Supply Cost

Please add total of all supplies cost and enter here.
Please attach original invoice if payment is to be made directly, or receipts if request is for reimbursement.
Drop files here or

Max. file size: 256 MB.
D. Miscellaneous
List Miscellaneous
Postage, printing, etc. List each item, cost.
Total Miscellaneous Cost

Please add total of all miscellaneous cost and enter here.
Please attach all miscellaneous invoices and/or receipts.
Drop files here or

Max. file size: 256 MB.
Total Disbursements Requested
Total Requested
$0.00
Confirm as lead grantee
- I certify that I am the lead grantee on this grant.
By checking this you are saying that you are the lead grantee on this grant.
F. Check Disbursements
Make Check Payable to (1)
Amount (1)
Address - where to mail the check (1)
Street Address Address Line 2 City State ZIP Code
Make Check Payable to (2)
Amount (2)
Address - where to mail the check (2)
Street Address Address Line 2 City State ZIP Code
Make Check Payable to (3)
Amount (3)
Address - where to mail the check (3)
Street Address Address Line 2 City State ZIP Code
Make Check Payable to (4)
Amount (4)
Address - where to mail the check (4)
Street Address Address Line 2 City State ZIP Code
Make Check Payable to (5)
Amount (5)
Address - where to mail the check (5)
Street Address Address Line 2 City State ZIP Code
Any additional comments or concerns?

Disbursement Form - Non-Personnel

A. Consultant Fees

B. Transportation Costs

C. Supplies

D. Miscellaneous

Total Disbursements Requested

F. Check Disbursements