Menstrual Dignity for Students: Program Reimbursement Form 2023-24

This form serves as your attestation to participation and compliance to all requirements of the law as well as for reimbursement of expenses related to Menstrual Dignity Act implementation, as per OAR 581-021-0587 through 581-021-0596. Reimburseable expenditures occur before June 30, 2024, which is the end of the spending period. Forms will be accepted on a rolling basis until August 14, 2024, and grant money available to claim on EGMS. Funds will be liquidated on August 14, 2024. After that point, funds will no longer be available to you.

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

Allocation ceilings for education providers will be based on the funding calculator found here, which uses data from the 2022-2023 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. Once this form has been processed, you will be able to claim funds on EGMS if you have requested them.

Remember, this form is required whether or not you are seeking grant funds.

Participant Details

Please let us know who we can reach out to if we have questions about this form. If you are applying for a grant 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.

Select
Caret IconCaret symbol

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.

Select
Caret IconCaret symbol

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

Select or enter value
Caret IconCaret symbol

Please select the charter school from the dropdown list.

Select or enter value
Caret IconCaret symbol

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.

Select or enter value
Caret IconCaret symbol

We'd like to hear from you! Please use this space to share student feedback or information about product usage. Let us know what is working in your community.

Please upload pictures of dispensers, invoices, or signage here. Photograph documentation is required as a record of your participation.

Drag and drop files here or

By submitting this document and checking the box below:


(1) You are attesting that your charter school, school district, or ESD is fully complying with all requirements of OARs 581-021-0587 through 581-021-0596. (2) You verify that the content you are submitting is true and understand that a false statement may lead to disqualification of benefits. (3) You agree to the above listed educational institution/fiscal agent receiving the reimbursement funds allocated by ODE via E-Grant Management System (EGMS). (4) You understand that to receive these funds, an authorized representative of the educational institution/fiscal agent must access and submit a claim through EGMS. (5) You understand that funds must be claimed in EGMS by August 14, 2024.

Thank you for your participation!

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

Heading