Illinois Program Director Reimbursement

Chicago PD Cohort/Personal Funds Application

This application can be used for:

Personal PD reimbursements (ex. parking for OneGoal events)

PD Cohort Funds (PD requesting reimbursement or request OneGoal make the purchase)

Note for PD Cohort Funds for Fellows:

As a reminder you can use your cohort funds for: program incentives (ex. fellow care package), gift cards, food requests, or bus requests.

Please note the following requirements related to this: Each PD gets $50 to use towards each cohort. If the request is over $50 or if you have already used your $50 budget, you will need approval from OneGoal.

After you submit this application: If your request warrants more information, you will get a calendly invite in the next 3-5 business days. If it does not require more information, you can expect to hear from a OneGoal staff member in 3-5 business days about the status of your request.

PD First Name

PD Last Name

PD Preferred Email

PD Phone Number

High School Name

Number of Cohort/Class Periods Requesting For

Some but not all of our PDs teach more than one section of OneGoal per year and that is why we ask this question.

PD Program Year/Years Requesting For

Y1Y2Y3Select all that apply

Would you prefer to...

Make the purchase yourself and get reimbursed by OneGoalHave OneGoal directly make the purchase Note: The request must be approved by OneGoal if over $50 in order to reimburse purchases.

What is your payment preference?

Direct Deposit (ACH form)CheckNote: OneGoal HIGHLY recommends a direct deposit. Direct deposits take about 2 weeks. Checks could take up to 6 weeks.

Please download this Payment Preference form, complete it, and then submit it here.

My purchase will be for...

Program Incentive Example: fellow care package (Y3)..... Other (Personal PD Reimbursement) Example: parking for OneGoal event

Is your request over $50?

NoYes, it is over $50

Is this your first request?

YesNo I have submitted other requests through this application

Please click here to make a forced copy of a google sheet. Fill it out and download as an excel file and save it as "Your First Name. Last Name. Date" and submit it here.

If this is not your first request, you will need to wait to be approved.

You will need to get approved by OneGoal before we can reimburse you. Please, in detail, write out what you purchased, the total amount spent, and the purpose behind it. You will hear back in 3-5 business days if it is approved for reimbursement.

Please upload the full receipt and make sure it is clear. Reminder: You need OneGoal approval for purchases or reimbursements over $50.

When do you need this request fulfilled by?

Please give us at least 5 business days.

How do you think this will impact the fellows you serve in planning or preparing for their postsecondary plan?

What are you wanting to purchase for fellows? Please add all helpful information such as : list of items, amount of each item, total amount, etc.

How do you think this will impact the fellows you serve in planning or preparing for their postsecondary plan?

What is the store name the purchase will be made from? Please add a website link if possible.

What is the restaurant's name, website, and contact number?

Check out this resource that lists local/POC-owned restaurants/catering.

What food are you wanting to purchase for fellows? Please add all helpful information such as : list of items, amount of each item, total amount, delivery address, etc.

Will this be for pickup or delivery?

Pick UpDelivery

Delivery/Pick Up Location

Delivery/Pick Up Time

Who is the contact person for the delivery?

This must be one of the people running the event.

What is the contact person's phone number?

How do you think this will impact the fellows you serve in planning or preparing for their postsecondary plan?

How many individuals are you requesting a bus for?

What is the bus company name and phone number you would like to use?

Please, in detail, write out the addresses for the pick up and drop off locations.

How do you think this will impact the fellows you serve in planning or preparing for their postsecondary plan?

What are you wanting to purchase for fellows? Please add all helpful information such as : list of items, link to website, amount of each item, total amount, delivery address, etc.

What did you purchase that you need reimbursed?

What was the purpose of your purchase?

What was the total amount of your purchase that you need reimbursed?

What was the date of purchase