CONTINUING EDUCATION FUNDS
CONFIRMATION FORM
As a part of your responsibility for the use of Continuing Education Matched Funds, you are required to submit this form within a period of ten (10) days following the completion of the education experience. Submit and return to the Church of God in Michigan, 4212 Alpha Street, Lansing, MI 48910, fax 517-393-7607 or e-mail.
Title of Program for which funds were used:
Location of Program:
Date(s) of Program:
How were the funds used:
Tuition/registration $
Food and Lodging $
Books/materials $
Other $
Please check one box.
This is a pre-request for funding of the above experience.
This is a post-request for reimbursement of expenditures in the above experience, and a report.
This is a report only of funds expended in the above experience.
Signature
Church
Date