Travel Authorization and Reimbursement Request Form by qCHm6S

VIEWS: 4 PAGES: 1

									                                                                                             TRAVEL AUTHORIZATION / REIMBURSEMENT REQUEST FORM

I. TRAVELER DATA:

Name                                                                                                                                 Department
Home Address                                                                                                                         Telephone Extension


II. TRIP DATA:
Dates                                                                                    Location/Destination
Purpose of Travel




EXPENSE DATA:
                                                                                                                                     IV. REIMBURSEMENT AMOUNTS
III. Travel Authorization
                    Estimate       Expense Type/Date                                                                                                                                                                                                  Total

                              $0   Conference/Fees                                                                                                                                                                                                    $0.00   1
                              $0   Air/Train                                                                                                                                                                                                          $0.00   2
                              $0   Rental Vehicle                                                                                                                                                                                                     $0.00   3
                              $0   Hotel (Lodging only)                                                                                                                                                                                               $0.00   4
                              $0   Meals*                                                                                                                                                                                                             $0.00   5
                              $0   Detail Sheet**                                                                                                                                                                                                     $0.00   6


                              $0            Grand Totals      $0.00          $0.00          $0.00            $0.00       $0.00          $0.00            $0.00        $0.00      $0.00            $0.00        $0.00          $0.00         $0.00     $0.00


Proposed Accounts:                                         * Attach receipts if daily total exceeds $60                                                                                                                        Prior Payments         $0.00
                                                           ** Attach detail sheet for mileage. Include receipts if total for taxis, parking and tolls                                                                       Account Distributions
                                                           exceed $25
                              $                                                                                                                                                                 Account:                                    #DIV/0!   $0.00

                              $                                                                                                                                                                 Account:                                    #DIV/0!   $0.00

                              $                                                                                                                                                                 Account:                                    #DIV/0!   $0.00

                              $                            Reimbursement Authorization                                                                                                          Account:                                    #DIV/0!   $0.00
                                                           I certify that the expenses listed above were actually incurred and were                                                                                         Total:          #DIV/0!   $0.00
Travel Authorization                                       necessary to fulfill the mission of the university.

Traveler               Date
                                                           Traveler                                              Date               Chair (All Travel)                             Date                    Dean ($1,501-$3,500)                        Date


Supervisor             Date
                                                           Provost/VP ($3,501-$10,000)                           Date               President ($10,001+)                           Date                    Budget Controller (All Travel)              Date


                                                                                         Disposition of Check:                      Mail to Above                             Hold for Pickup


                                                                                         WHITE ORIGINAL: Accounts Payable/ CANARY: Traveler/ GREEN: Misc / PINK: Traveler

								
To top