Purchase Order Explanation Form

Name of Learner: _______________________________________

Amount Allocated:	$___________________
Amount Spent:	$___________________
Balance:	$___________________

Remaining funds will be allocated as follows:

o Reimbursed with the Learner's next funding request.

OR

o Learner will not request reimbursement for funds spent over the amount received.

Authorized By: ______________________________________ ______________

Name of Resource Consultant Date