Travel Reimbursement Form for Summit

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					                          Colorado Legacy Foundation
                      Travel Reimbursement Request Form
EVENTS:

        March 5, 2012 – Colorado Educator Effectiveness Summit: 191 Into Action

        March 6, 2012 – Colorado Standards Implementation Summit

WHAT WILL BE REIMBURSED?

Mileage

        District teams that travel more than 120 miles to the event site (Westin Hotel in Westminster),
         will be reimbursed for mileage at the IRS reimbursement rate. Mileage is calculated based on
         the distance of the school district main office to the event.
        Only mileage for one car per district will be reimbursed for attending the March 5th Event.
         District teams are encouraged to travel together.
        If additional district staff attends the March 6 event only, mileage for one additional car per
         district can be reimbursed.
Hotel

        Participants whose school district is more than 180 miles away from the event site, are eligible
         for hotel reimbursement for up to $122.75/per room (including tax) per night.
        A maximum of 4 hotel rooms per night, per district will be reimbursed.
        District teams attending only one of the events – March 5 or March 6 - would be eligible for
         hotel reimbursement for one night.
        District teams attending both the March 5 and March 6 event would be eligible for hotel
         reimbursement for up to two nights.
        Receipts showing amount paid must be submitted to receive reimbursement.

PLEASE COMPLETE THE FOLLOWING INFORMATION:

Which event (s) did you attend?

March 5___               March 6___              March 5 and March 6___

Name (to appear on check):

Contact Name: ___________________________________________________________________

Address:

City:                                               State:           Zip code:

Organization/School/School District: _________________________________________________

Phone:

Email:


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                       Colorado Legacy Foundation
                   Travel Reimbursement Request Form



I wish to be reimbursed for the following:

Mileage               $ ________
Hotel                 $ ________
Total Amount of Reimbursement: $______________




Reimbursement request forms must be submitted no later than    March 30, 2012 to be
eligible for reimbursement. Please submit form and receipts to Tara Jahn at
tjahn@colegacy.org, fax (866) 611- 7509, or mail to Colorado Legacy Foundation – 1660
Lincoln Street Suite 2720 Denver, CO 80264.




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