ESA · Purchase Request Templates · State Guide
ESA purchase request templates by state: Arizona, Wyoming, Montana, Tennessee
An ESA purchase request is a formatted document for requesting payment or reimbursement from your state’s ESA program. Arizona uses ClassWallet’s submission workflow. Wyoming operates on a 30-day reimbursement rule. Montana has referenced MapQuest-style mileage documentation. Tennessee may require preapproval for certain expenses.
Last verified: · Sources: Arizona ADE; Wyoming DOE; Montana OPI; Tennessee DOE; Texas TEFA rules
Preapproval vs. reimbursement: what model does your state use?
| State | Payment model | Preapproval note |
|---|---|---|
| Arizona | ClassWallet direct payment + reimbursement | Some categories may require documentation review first |
| Wyoming | Reimbursement (30-day window) | No blanket preapproval — families pay first, submit within 30 days |
| Tennessee | Preapproval for certain categories | Department approval required for some expenses per statute |
| Montana | Reimbursement (verify program status) | Court stay may affect availability — check with MT OPI |
| Texas TEFA | Odyssey platform (direct payment) | Vendor and offering-level approval before families can spend |
Template 1: General ESA purchase request / reimbursement submission
Use this as your baseline. Adapt it for your state’s specific requirements.
ESA PURCHASE REQUEST / REIMBURSEMENT SUBMISSION
State / Program: ________________________________
Account holder (parent/guardian name): __________
Student name: ___________________________________
Account or student ID: __________________________
Date of request: ________________________________
PURCHASE DETAILS
Vendor / provider name: _________________________
Item or service description: ____________________
Category: ______________________________________
Purchase date: __________________________________
Amount: $______________________________________
DOCUMENTATION ATTACHED
[ ] Itemized receipt
[ ] Proof of payment (bank/card statement or cleared check)
[ ] Preapproval confirmation (if required)
[ ] Vendor invoice
PREAPPROVAL (if required by state)
Required for this category? (Y / N): ___________
Preapproval reference or date: _________________
SUBMISSION PLATFORM
[ ] ClassWallet submission
[ ] State portal reimbursement form
[ ] Other: ____________________________________
Submitted by: __________________________________
Submission date: _______________________________
Confirmation number: ____________________________
Template 2: Arizona ClassWallet submission checklist
Arizona families use ClassWallet’s workflow. Use this checklist before you submit through the platform.
ARIZONA ESA — CLASSWALLET SUBMISSION CHECKLIST
Student account name / ID: _____________________
Submission date: _______________________________
[ ] Item/service description matches ClassWallet category
[ ] Vendor is a ClassWallet-participating vendor or
is being submitted as a reimbursement
[ ] Receipt is itemized (not a summary total)
[ ] Receipt is non-handwritten (typed, printed, or electronic)
[ ] Proof of payment attached (bank/card statement)
[ ] Amount matches receipt exactly
[ ] Purchase is in ADE ESA allowable category
ClassWallet submission type:
[ ] Direct payment to vendor
[ ] Reimbursement to parent
ClassWallet transaction / reference ID: _________
Status: [ ] Pending [ ] Approved [ ] Denied
Template 3: Wyoming ESA reimbursement submission checklist
Wyoming 30-day deadline:
Your submission must arrive within 30 days of the purchase date. Calculate your deadline immediately and set a calendar reminder.
WYOMING ESA — REIMBURSEMENT SUBMISSION CHECKLIST
Student name / account: ________________________
Purchase date: __________________________________
30-day submission deadline: ____________________
(= purchase date + 30 calendar days)
[ ] Receipt is NOT handwritten
[ ] Receipt is itemized
[ ] Vendor name on receipt
[ ] Purchase date on receipt
[ ] Amount on receipt matches proof of payment
[ ] Proof of payment attached
[ ] Expense category checked against WDE
Allowable/Disallowable Expense Guidance
[ ] Submission is within 30 days of purchase
MILEAGE (if applicable)
Start address: _________________________________
End address: ___________________________________
One-way distance (miles): ______________________
Number of trips: _______________________________
Total miles: ___________________________________
IRS mileage rate used: $_______________________
Total mileage reimbursement: $__________________
Mapping tool printout attached: (Y / N)
WDE submission date: ____________________________
Confirmation number: ___________________________
Template 4: Montana ESA mileage reimbursement documentation
Montana program status:
Montana’s ESA program may be affected by a court-ordered stay. Verify current program operation with the Montana Office of Public Instruction before submitting any request.
MONTANA ESA — MILEAGE REIMBURSEMENT DOCUMENTATION
Student name / account: ________________________
School or service address: _____________________
Trip details:
Origin address: ________________________________
Destination address: ___________________________
Round trip: (Y / N)
Distance per trip (one way): _____ miles
Number of trips this period: ___________________
Total miles: ___________________________________
Mapping tool used (e.g., MapQuest, Google Maps): ___
Mapping printout attached: (Y / N)
Mileage rate: $________________________________
(Use current Montana OPI rate or IRS rate — verify)
Total mileage reimbursement: $__________________
Submission date: _______________________________
Confirmation: __________________________________
Template 5: Tennessee preapproval purchase request
Tennessee’s ESA statute requires department approval for certain expense categories. Use this template when submitting a preapproval request before a purchase.
TENNESSEE ESA — PREAPPROVAL PURCHASE REQUEST
Student name: ___________________________________
Parent/guardian: ________________________________
ESA account ID: _________________________________
Date of request: ________________________________
PROPOSED PURCHASE
Vendor / provider name: _________________________
Item or service description: ____________________
Expense category: _______________________________
Estimated amount: $_____________________________
Proposed purchase date: _________________________
EDUCATIONAL PURPOSE
How this purchase supports the student's education:
_______________________________________________
ATTACHMENTS
[ ] Vendor information or quote
[ ] Product description or service agreement
[ ] Other supporting documentation
I understand this request is for preapproval and that
approval is required before this purchase is made.
Submitted by: __________________________________
Date: _________________________________________
What to include in every purchase request regardless of state
- Student name and account or ID number
- Parent or guardian name
- Vendor or provider name
- Item or service description
- Expense category
- Purchase date or proposed date
- Amount
- Documentation attached (receipt, proof of payment, preapproval)
Related guides
Frequently asked questions
What is an ESA purchase request template?
An ESA purchase request template is a formatted document you prepare before or after buying an educational item or service, to request payment or reimbursement from your state's ESA program. In some states, it is used for preapproval before purchase. In others, it accompanies a receipt for reimbursement. The format depends on your state's program and the type of purchase.
Does Arizona use a purchase request form for ESA spending?
Arizona's ESA uses ClassWallet as the payment platform, which has its own submission workflow. The 'purchase request' in Arizona typically means a purchase submission through ClassWallet — either a direct payment to a participating vendor or a reimbursement submission. You do not mail a paper form in most cases. You follow the ClassWallet workflow and attach the required documentation.
Does Wyoming have an ESA purchase request form?
Wyoming's ESA program has specific documentation requirements but operates through the Wyoming Department of Education's ESP system. Families submit receipts within 30 days of purchase. Wyoming's guidance focuses on what documentation must accompany a reimbursement submission, rather than a preapproval request form. The key Wyoming rules: 30-day window, no handwritten receipts, itemized documentation required.
What is the Montana ESA mileage reimbursement process?
Montana's ESA materials have referenced MapQuest-style mileage documentation for transportation reimbursement. That means a printout or screenshot from a mapping tool (showing start address, end address, and distance) can support a mileage reimbursement claim. Montana's program availability may be affected by a court-ordered stay — always verify current program status with the Montana Office of Public Instruction before submitting.
What is the difference between preapproval and reimbursement in ESA programs?
Preapproval means you submit a purchase request to the state or program administrator before you spend the money. The program reviews and approves or denies the purchase in advance. Reimbursement means you pay first, then submit receipts and documentation to get the money back. Some states require preapproval for certain categories; others use only reimbursement; some use a mix. Knowing which model your state uses for which expense type is essential.
How should a purchase request for tutoring ESA services be formatted?
A tutoring purchase request or reimbursement submission should include: tutor name and credentials, subject and grade level, session dates and duration, rate per session or total amount, and any preapproval confirmation if required. This is different from a curriculum purchase, which focuses on the product name, publisher, category, and quantity rather than session dates.
What information goes on an ESA purchase request for curriculum?
A curriculum purchase request should include: publisher and product name, grade level, subject, cost, vendor name, whether the vendor is approved in the state, and the educational purpose of the material. In ClassWallet states, this information is often part of the submission form itself. In reimbursement states, it appears on the invoice or receipt you attach.