Ex Libris Subscription Request for Reimbursement FY22-23

Participating organizations will use this form to submit a request for reimbursement of their FY22-23 Ex Libris software subscription expenses incurred between July 1 2022 and June 30 2023.

This request is made on behalf of the following organization:

Ex Libris software subscription reimbursement is limited to participating colleges. Please select the college making this request from the list below.

Requestor's Name

What is your name? Our team will work with you to answer questions and coordinate payment details.

Requestor's Title

What is your title at your organization?

Requestor's Email Address

What is your email address? We will contact you with status and collaborate with you on any questions.

Requestor's Phone Number

What is your phone number?

Signatory/Certification person for your College

Please identify who will be responsible for signing/certifying this request.

Signatory/Certification Title

Please provide the title of the signatory person for your College.

Signatory/Certification Email Address

Please provide the email address of the signatory person for electronic signature. Please note that we will be sending an email from AdobeSign to this address to collect an electronic signature.

Requested Reimbursement Amount

Reimbursement is limited to the Ex Libris software subscription amount shown on the League invoice(s) for the 22-23 fiscal year only.

Describe the Activity this reimbursement covers:

Confirm that the activity below that this reimbursement will cover for your organization.

Supporting Documentation - Five (5) Documents Required per Fiscal Year

Please attach the following in PDF format:

1.) 2022 Community College League of California (CCLC) invoice showing the description of the billed items and amount billed to your District/College.

2.) Proof of payment 2022: A copy of the detailed general ledger (i.e. budget/expenditure report) produced by the District's/College's official accounting system, or check copy, clearly reflecting the CCLC 2022 invoice payment.

3.) 2023 Community College League of California (CCLC) invoice showing the description of the billed items and amount billed to your District/College.

4.) Proof of payment 2023: A copy of the detailed general ledger (i.e. budget/expenditure report) produced by the District's/College's official accounting system, or check copy, clearly reflecting the CCLC 2023 invoice payment.

5.) An up-to-date W-9 for your college or District. The address on the W-9 is where the reimbursement check will be mailed.

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