Sigma Theta Tau International, Inc.
HONOR SOCIETY OF NURSING
Xi Rho Chapter
 Clayton State University
School of of Nursing
2000 Clayton State Boulevard
Morrow, GA 30260

Treasury Reimbursement Form

Name:                                                               Date ________________________________________________________________________________

Reason for Reimbursement: ______________________________________________________________
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Amount Requested: ______________________________________________________________

Signature: ______________________________________________________________
Receipt Attached:  yes/no ______________________________________________________________
If no receipt, please explain: ______________________________________________________________

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Reimbursement paid by:

Name                                Check #                              Date
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