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2019 LSTA Technology Grants Reimbursement and Evaluation

How to Claim Reimbursement

  • Download the Excel file of the GAX form to type in the form.
  • Download the PDF GAX form if you do not have MS Excel or similar spreadsheet software and will hand write it.
  • Fill in the form where indicated on the sample GAX form (all highlighted areas.)
  • List the items you purchased on separate lines.
  • Try to make the listing on the GAX form as close to your list in your grant application as possible.
  • You can combine things from different vendors on the same line, but the description is what is most needed.
  • Total amount requested for reimbursement cannot be more than the amount requested in your grant application.


The GAX needs an original signature.
Sign it, attach all documentation, and mail it to:

State Library of Iowa
Attn: Samantha Berch
1112 E Grand Ave
Des Moines, IA 50319



Documentation is copies of:

  • order confirmations
  • invoices, or bills
  • credit card statements with purchase circled
  • copies of checks used to pay it
  • payment confirmation for online purchases
  • packing slips
  • anything that shows you ordered it, received it (like packing slips), were charged for it, and paid it

Download
Sample
GAX form

Download
GAX form
in Excel

Format

Download
GAX form
in PDF

Format

Evaluation

The evaluation will be conducted using Project Outcome. This is a work in progress. More information and instructions will be posted here.

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