Allowable Purchases Through

ALLOWABLE PURCHASES THROUGH (Name of store)

Only items listed below are to be purchased. Maximum for each child: $250.00

1. Clothing: (pants, shirts, socks, underwear, etc.) 2. Shoes 3. Coats/jackets 4. Personal hygiene/grooming items: (shampoo, conditioner, soap, deodorant, toothpaste, toothbrush, comb, brush, etc.) 5. School Supplies: (Binder, notebooks, notebook paper, pencils, pens, crayons, markers, scissors, glue, ruler, etc.)

Note: Clothing should be student sized, no infant/toddler, but could be adult size for a middle or high school age child. Directions: Present completed voucher to the Manager at (Name of Store) PRIOR to making selections. VOUCHER IS VALID FOR 30 DAYS FROM DATE OF SIGNATURE

(Insert Name) COUNTY SCHOOLS Families in Transition (FIT) Program

(Insert name of store) PROGRAM VOUCHER

School: Elementary

Student Name:

Parent/guardian:

This voucher will serve to indicate eligibility of the above named student for ______County Schools FIT Program Services. Upon presentation of this signed voucher to:

(Name of store)

The parent, guardian or authorized representative of the above named child will be able to purchase any of the items listed below at no cost to the child or child’s family. Expenditures to a maximum of $250.00 will be paid to (insert name of store) by (insert name of district).

Allowable items: a. Clothing, (pants, shirts, socks, underwear, etc.) b. Shoes c. Coats/jackets d. Personal hygiene items (shampoo, conditioner, soap, deodorant, toothpaste, toothbrush, comb, brush, etc.) e. School supplies, (paper, notebook, pencils, pens, binder, etc.)

Principal: Please review and sign below to approve services for the above named student.

Principal’s signature: Date:

Authorized by:

(insert name and Title) VOUCHER IS NOT VALID WITHOUT ORIGINAL SIGNATURES AND DATE IN BLUE INK. NO PHOTOCOPIES WILL BE ACCEPTED! VOUCHER IS VALID FOR ONLY 30 DAYS

For questions: Call(insert name of contact person) at (insert phone number) Voucher Number: Number ____ Not valid after: (insert date)

Developed by N. Dotson, Boone County Schools, WV