Facilitator Invoice

Please complete this form:

1. Facilitator Name
Point and click on (select) your name from the list. (It will be shaded.)

Aysha Haq Leslee Currie Linda Davidson Linda Glas Marci Swindell Michele Anciaux Aoki Pastor Bill Clements Tammy Clark Tiffany Brown

2. Network Name
Point and click on (select) Network Name from the list. (It will be shaded.)

Adam Alison Anna David Dina Jay Kari Katie Kelly Jerry Mark Matteo Sheri

3. Month/Year of Invoice (select from each box)
Please submit hours for only one month at a time. If you have multiple months, please submit multiple forms. Thank you!

Month January February March April May June July August September October November December     Year 2008 2009 2007

4. Network Facilitation Activities

Example Format (one day per line):  
3/2/2007 Network meeting (2 hrs)
3/3/2007 Summary Report (1 hr)
3/31/2007 Phone calls, Emails during the month (.5 hr)
Total 3.5 hrs

Note: LifeSPAN does not usually pay for mileage unless that is part of the agreement with the family (for example, if some network meetings are held at a more distant location). If you need to bill mileage, add that information after the hours, for example,
3/25/2007 Dinner with focus person (1 hr) (14 miles)
3/31/2007 Phone calls, Emails during the month (.5 hr)
Total 1.5 hrs; 14 miles

5. Activities charged to LifeSPAN

Note: Be sure that this time has been pre-approved by the Facilitator Coordinator

Example Format:  
4/7/2007 Attended LifeSPAN facilitator training (1 hr)
Total 1 hr

6. Other Notes to the Facilitator Coordinator

Click Submit to send this information to the LifeSPAN Office or Reset to display a blank form. After clicking Submit, you will see a confirmation page display.