Prescription Safety Glasses Reimbursement Form

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Prescription Safety Glasses Reimbursement Form

This form is valid towards the purchase of prescription safety glasses to be worn during work. The reimbursement amount is $175. The employee is responsible for any costs exceeding $175.

Please fill out this form and attach receipt(s) in the designated field.

NOTE: This form is only required for safety glasses purchased outside of the District’s contracted programs with Zenni and National Vision/America’s Best. Employees purchasing safety glasses through Zenni or National Vision/America’s Best should not use this form.

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    05/17/2026