Supply Request Form- Partnership Scholars Program printable pdf download

Supply Request Form- Partnership Scholars Program

Partnership Scholars Program

REQUEST TO SPEND OVER $150 ON A SINGLE ITEM

Mentor Name

____________________________________________________________

Scholar Name

___________________________________________________________

What do you want to purchase and what is the cost?

__________________________________________________________________

How would this expenditure benefit the scholar in regard to college access & success?

__________________________________________________________________

Describe your scholar’s research on the item.

__________________________________________________________________

If approved, will you need PSP to pay via PSP credit card?

Yes (Circle one)

If Yes, Please provide the following:

URL or Phone number to make purchase: _____________________________________

Exact item name/description: _____________________________________________

Quantity: ______ Cost Per Item: _____ Total Amount of Purchase: __________

Mentor Signature ____________________________________ Date __________________

Please email this form to Maria Hernandez at

Or mail to: PSP, P.O. Box 156, El Segundo, CA 90245

(Please allow at least 10 days for approval)

PSP Office Approval ______________________________________ Date ________________

Supply Request Form- Partnership Scholars Program