Travel Expense Form Date Place Traveled

							                                               JEFFERSON COUNTY SCHOOLS
                                                  TRAVEL EXPENSE FORM
Note: See Jefferson County Board Policy concerning Travel
For Period From ____________________ To____________________                                                   Page _____of _____ Pages

                                                            Total            Summary of Expenses Incurred
Date        Place Traveled & Purpose of Travel              Miles       Mileage       Food          Motel     Misc.    Total Expenses
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                                         0
                                                                                  0                                    $                -
Mileage - $0.46 per mile effective January 1, 2010
Lodging: Reimbursable lodging expenses will be reimbursed at the standard room rate or approved conference room rate. Always
Reimbursement or government rate. conferences, seminars or for the entire amount must be submitted.
request the stateof registration fees forThe original lodging receiptmeetings will be allowed provided advanced approval is obtained from
the appropriate administrator. If advanced checks for lodging are required, contact Accounts Payable at the Finance Department.

Meals shall be reimbursed up to $30.00 per day. List names of persons you have paid meals for and their relationship to the event, if you
pay for someone else. Original detailed receipts must be submitted for reimbursement of these meals and incidentals, i.e., taxi fares,
Claims for reimbursement should be paid within two (2) weeks from receipt of the form at Jefferson County Finance Department.
Claims submitted after thirty (30) days must include an explanation of the delay. If travel is paid through Federal Program, the Federal
Director must verify this as an allowable expense.



Please send check to ________________________________ at ______________________________________________.


I hereby certify that this claim is true and correct:
                                                                                      Signature of Claimant
Print Name of Claimant:                                                                                                Date

Program Director                                                        Approved                                       Date
                      (Please Print)                                                  (Signature)