CIO Grant Program Reimbursement Expense Form

This form is to be used by CIOs who have received grant funding and need to have their eligible expenses reimbursed. Upon submitting this form to the City of Tualatin, it may take 2-3 weeks to receive your reimbursement. If you have questions regarding the program, please call (503) 691-3050 or email dhudson@tualatin.gov

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CIO Name *

CIO Representative Name *

E-mail Address *

Phone Number *

Expenses
Date	Description	Amount
Date Month Day Year	Description	Amount

CIO Grant Program Reimbursement Expense Form

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