Forms and Documents

Region 12 Forms and Documents for 2017-18

September 24, 2017  |   Comments Off on Region 12 Forms and Documents for 2017-18

Note: Always first download the form you click on below to your desktop or another folder, and then open it in Adobe Free Reader. Opening within this website directly will either cause it to not render, or will not allow the fillable sections to operate properly. Get the latest version of Adobe Free Reader here (cut and paste hyperlink into your browser)  and download to your computer:


Reimbursement Forms–Use these forms for region-approved expense claims. Note that the mileage form should be done 2x per year, once after January 1 and again after July 1.

mileage reimb form ACSA R12_reader_extended

reimbursement request form R12 fillable_reader_extended


Charter Financial Statements–Use these two forms to apply for your yearly charter allotment from the region of $300.

Charter_Financial_Statement_last_ year_reader_extended

Charter_Financial_Goals current year_reader_extended


Activity Design Project Form–Charters may use this form to request region funds for a special charter event or other project.


activity project design form rev 3 1 18

Charter Board Roster Reporting Form–Charter presidents or secretaries should use this form to report each new academic year’s charter board lineup to the region.

charter board roster reporting form


Charter Presidents Demgraphics Reporting Form–

Charter Presidents demographics form R12_reader_extended


Member Inquiry Form–This form is used to report changes in your contact info to the region and state, e.g. change of job, district, address, even region changes.



ACSA Academy Scholarship Request Forms (for SAC charter only from REM charter)

Application form for ACSA Academies scholarships REM_reader_extended

SAC REM ACSA academies scholarship request instructions SAC Scholarship Reimbursement Request Form for ACSA Academies from REM_reader_extended

SAC REM ACSA academies scholarship request instructionsApplication form for ACSA Academies scholarships REM_reader_extended






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    • R-12 High School Scholarships Applications for 2017-18 March 11, 2018
      Again this year, Region 12 will offer tyhree $1000 scholarships to children/grandchildren of ACSA R-12 members in good standing. The deadline to submit the form is 11:59 PM on March 19. Contact Consultant Bill Olinger at if you have not yet received the form via email blasts. (This website does not support attached “fillable” […]