Swarthout Foundation
Swarthout Foundation
Disbursement Report Form
The following payment has been made from grant funds of the Swarthout Foundation for the purposes noted:
Student’s Name:_____________________________________________
Date:_______________ Amount:________________ School: CAPITAL HIGH SCHOOL
Payment made to:_____________________________
Payment made for:_____________________________
Coordinator of Fund____________________ Administrator______________________
*NOTE: RETAIN IN YOUR BUILDING FILES FOR 3 YEARS, THEN DESTROY.