Menstrual Dignity for Students: Program Reimbursement Form 2021-22

Please complete this form for expenses related to the Menstrual Dignity Act implementation, as per OAR 581-021-0587 through 581-021-0596.

Reimbursements related to the Menstrual Dignity Program, per OAR 581-021-0587 - 0596.

Allocation ceilings for education providers will be based on a funding calculator (https://bit.ly/306XiBF) which uses data from the 2020-2021 school year, based on second period cumulative ADM. Reimbursement is allowable up to the allocation. As per 2021 Menstrual Dignity Act (HB 3294), districts may receive funds individually or through their Education Service District (ESD) and public charter schools may receive funds individually or through their School District sponsor.

Requestor Details

Please let us know who we can reach out to if we have questions about your grant. If you are applying as a consortium, please identify the person who will be coordinating between all institutions represented in the grant.

Phone

Please indicate whether you're representing an ESD, School District, or a Public Charter.

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Please enter the 4-digit ODE Institution ID # or Vendor ID # of the Fiscal Agent. For education institutions, this may be the same as listed in the dropdown below, and can also be found here: https://www.ode.state.or.us/instID/

If yes, please select all education providers represented from the dropdown lists provided in the next 2 questions.

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Please select the Institution from the drop down list, as listed on the funding calculator and in ODE's Electronic Grant Management System (EGMS).

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Please select the charter school from the dropdown list.

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Itemized Expenditures for Reimbursement

The following are the allowable expenses outlined in OAR 581-021-0600-0609. Please refer to the OAR for definitions of these individual items.

Enter the total cost paid for menstrual product dispensers.

Enter the total cost paid for menstrual products purchased.

Enter the total cost paid for installation of product dispensers.

Program Implementation Support

Please refer to our Menstrual Dignity for Students Program Implementation Toolkit and reach out to ode.menstrual-dignity@state.or.us if you need additional support.

Please include a contact name and e-mail for program implementation (if different than contact included above)

We want to ensure you have the support you need in order to implement this program successfully for all students. In order to ensure student access and equity is at the center of your decisions, consider pillar recommendations for each toolkit section, including physical dispenser locations, product selection, program language, educational materials, student, family, and community engagement, and staff training. Please refer to page 4 of the toolkit for information on each pillar of menstrual dignity.

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We'd like to hear from you! Please feel free to share a description, attach photos of dispensers or signage, share student feedback and let us know what is working in your community.

Please upload any pictures, sample program materials, or other documents you would like to share with us here.

Drag and drop files here or

(1) You verify that the content you are submitting is true and understand that a false statement may lead to disqualification of benefits. (2) You agree to the above listed educational institution/fiscal agent receiving the reimbursement funds allocated by ODE via E-Grant Management System (EGMS). (3) you understand that to receive these funds, an authorized representative of the educational institution/fiscal agent must access and submit a claim through EGMS.

Thank you for your participation!

Please contact us if you have any comments, questions or concerns at ode.menstrual-dignity@state.or.us.

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