Facilitator Invoice

Please complete this form:

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

Beth Angelo Carmella McMurry Emily Ehrhart Irene Miller Leigh Young Leslee Currie Linda Glas Marci Swindell Matt Swank Monique Nilsen Nancy Slocum Patty Bodzioch Tammy Clark Teresa Woods

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

Adam Alison Anna Bella David Dina Eric Erin Jay Kari Katie Kelly Jerry Lily 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 2010 2009 2008 2007

4. Network Facilitation Activities

Example Format (one day per line):  
3/2/2010 Network meeting (2 hrs)
3/3/2010 Summary Report (1 hr)
3/31/2010 Phone calls, Emails during the month (.5 hr)
Total 3.5 hrs

Note: LifeSPAN facilitators may charge for mileage at the IRS stated rate (which, beginning in January 2010 will be .50 per mile) under the following conditions:

When they are traveling to or from a network meeting where their attendance is required.
When the facilitator is traveling with a focus person in their car.
When the need for travel and the estimated distance is agreed to in advance with the member family.

If you need to bill mileage, add that information after the hours, for example,
3/25/2010 Dinner with focus person (1 hr) (14 miles)
3/31/2010 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:  
4/7/2010 Attended LifeSPAN facilitator training (1 hr)
Total 1 hr

6. Other Notes to the Facilitator Coordinator

If you are ready to submit the form, please type the word "Submit"
(first letter capitalized) in this space then...

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.