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Disbursement Request

Fields marked with an * are required.

Reimbursement Request Details

Request Date: 10/15/2026

Reason for Disbursement*

Conference*

Description*

Name of Conference*

Conference Start Date*

Conference End Date*

Name*

First Last

Email*

Phone*

Expenses

Mileage is reimbursed at the current IRS rate of 76¢ per mile. Select Mileage as the category and enter the number of miles — the amount will calculate automatically at 76¢ per mile.
For the mileage receipt, please provide a map showing the mileage to and from your destination.
Travel is reimbursed at the least expensive option (airfare, train, mileage, etc.) unless another option is pre-approved.
Meal reimbursement amount is dependent upon the association’s policy.
Portage is reimbursed up to $8 per day. (No receipt required for portage.)
If you do not have a receipt for a line, use that line’s No Receipt button to explain why.

Please itemize each expense below and attach a receipt for each line.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Date*

Check Out*

Category*

Description

Number of Miles*

Amount*

Amount

Receipt

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 128 MB, Max. files: 10.

Additional Lines

Total Disbursement Amount

Reimbursement Method

How would you like to be reimbursed?*

Name on Check*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name on Zelle Account*

Provide the email and/or phone number associated with your Zelle account below. If you are not sure which one you registered, provide both.

Zelle Email Address

Zelle Phone Number

You will be notified when your check is ready to be picked up. Please pick up your check at the NOCUT office at 749 South Brea Blvd, Suite 42, Brea, CA 92821 between the hours of 8:30–4:30 Monday through Thursday and 8:30–3:30 on Fridays.

CAPTCHA

*All information will be verified by the association President and Treasurer prior to issuing a reimbursement.

Five chapters.
One voice.

Serving 1,800 education professionals across five North Orange County school districts since 1975.

SCROLL

Chapters

NOCUT exists to serve its five member associations. Find yours.

BOTABrea Olinda Teachers Association

BPTABuena Park Teachers Association

FETAFullerton Elementary Teachers Association

FSTOFullerton Secondary Teachers Organization

LHEALa Habra Education Association

About

A UniServ founded in 1975 by agreement between North Orange County teachers, CTA, and NEA.

The Board of Directors is elected from the five chapters and meets monthly in open session to oversee the UniServ budget, direct the work of the UniServ staff, and run member trainings and service programs. CTA assigns a full-time professional staff member to the office.

1975Founded

5Districts

1,800Members

Board of Directors

Elected from the membership of all five chapters. Meets the second Wednesday of each month at 4:30 PM.

PRESIDENT

Shannon Belknap

LHEA

VICE PRESIDENT

Shelley Behrns

FETA

SECRETARY

Glenda Bartell

BOTA

TREASURER

Jason Gaw

BPTA

BOTA

Glenda BartellPresident
Michael MaRepresentative

BPTA

Jason GawCo-President
Gil KimCo-President
Lynn SipesRepresentative

FETA

Shelley BehrnsPresident
Clara KollmansbergerRepresentative
Jenn HughesRepresentative

FSTO

Magdalena VillalbaPresident
Ken EavesRepresentative
Lisa ValdesRepresentative

LHEA

Shannon BelknapPresident
Danette BrownRepresentative

Reach the Board at info@mynocut.org.

Office

The NOCUT office supports the Board and the day-to-day business of all five chapters.

CTA UNISERV STAFF

Natalie Dorado

OFFICE STAFF

Matthew VirdenAdministrative Assistant
Patty CanalAdministrative Assistant

EMAILinfo@mynocut.org

PHONE(714) 256-9900

ADDRESS749 S Brea Blvd, Suite 42
Brea, CA 92821

HOURSMonday to Thursday, 8:30 to 4:30
Friday, 8:30 to 3:30

Calendar

Board meetings, CTA conferences, and district holidays.

Disbursement requestReimbursement for conference travel and other approved expenses.

Five chapters.One voice.

Chapters

About

Board of Directors

PRESIDENT

VICE PRESIDENT

SECRETARY

TREASURER

BOTA

BPTA

FETA

FSTO

LHEA

Office

CTA UNISERV STAFF

OFFICE STAFF

Calendar

Five chapters.
One voice.