Travel Reimbursement Form

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					TRAVEL REIMBURSEMENT REQUEST FORM
Name:
Campus Wide ID

Dept:                                                                                  Please attach receipts, conference
Campus Ext.                                                                            brochure and agenda to the back

Charge to Account                   AF                                                 of this form. Do not include

                                                                                       Meal receipts.


CONFERENCE NAME                                                                        How did you pay for your registration? __ Self __ P-card
PO# FOR CONF. REGISTRATION A                                                           If you paid for the conference
CONFERENCE LOCATION                                                                    registration yourself, please include copy
CONFERENCE DATES      Begin                                        End                 of receipt, copy of cancelled check front/back
HOW DID YOU GET TO CONFERENCE?                                                         or P-Card receipt.
             Please check     Fly
          the appropriate     School Vehicle                Tag Num:
                      box     Personal Vehicle              Please complete the Mileage Log Section.

PER DIEM                      In-state       $39.00         Requires an overnight stay at approved hotel.
                              Out-of-state
                      Varies-See www.policyworks.gov/perdiem for each state rate
Per Diem is figured based on the time you enter and depart travel status. Meals provided by the
conference are deducted according to the city, state perdiem rate
Continental breakfast provided by hotel or conference is not counted as a meal provided.
Date & Time entered travel status                                                       A.M or P.M.
Date & Time departed travel status                                                      A.M. or P.M.
Number of meals provided by conference.                                                (Do not include continental breakfast.)
Time and date of the first meeting attended
Time and date of the last meeting attended

HOTEL                       The original copy of the hotel bill showing $0 balance due for the room and tax only must be attached.
                            All incidental expenses, (I.e. movies, room service, personal telephone calls, etc.) must be
                            paid by the employee at check out and should not be included on the hotel bill.
Hotel direct billed to OSU-OKC ?              Y/N             Cost of Hotel?
Is hotel designated conference site?             Yes                  No
If hotel is not conference site, then an Employer Designated Lodging form must be attached or the
state rate as listed on www.policyworks.gov/peridem will be paid.
An original copy of your hotel bill must be provided even if the hotel agrees to send an invoice.

MISCELLANEOUS
EXPENSES                                                                 Please attached receipts
                                                                         to the back of this form.



MILEAGE LOG                   Mileage will be reimbursed at $0.555 per mile (effective July 1, 2011)
Vehicle License Tag #


                                             Odometer Readings                         Departure Return
To                                           Beginning Ending               Miles        Time     Time            Purpose




PLEASE STAPLE ALL RECEIPTS, ALONG WITH COPY OF CONFERENCE BROCHURE AND AGENDA TO THE BACK
OF THIS FORM AND SUBMIT TO JANET BRYANT, BUSINESS SERVICES, AD228,FOR REIMBURSEMENT.
IF YOU HAVE QUESTIONS REGARDING THE COMPLETION OF THIS FORM, PLEASE CALL x249 OR EMAIL janetbl@osuokc.edu.

Applicant Signature: _______________________________________________________________
TRAVEL REIMBURSEMENT REQUEST FORM
Name:

S.S.. #                                                                                  Please attach receipts, conference

Dept:                                                                                    brochure and agenda to the back

Campus Ext.                                                                              of this form.
Account #


CONFERENCE NAME
PO# FOR CONF. REGISTRATION                               A                               If you paid for the conference
CONFERENCE LOCATION                                                                      registration yourself, please include copy
CONFERENCE DATES                                                                         of receipt or copy of cancelled check front/back.
HOW DID YOU GET TO CONFERENCE?
           Please check       Fly
          the appropriate     School Vehicle
                     box      Personal Vehicle               Please complete the Mileage Log Section.

PER DIEM                      In-state         Varies        Requires an overnight stay at approved hotel.
                           Out-of-state  Varies - Consult website www.policyworks.gov/perdiem
Per Diem is figured based on the time you enter and depart travel status. Meals provided by the
conference are deducted based on the perdiem rate for that city and state.
Continental breakfast provided by hotel or conference is not counted as a meal provided.
Date/Time entered travel status                                                            A.M or P.M.
Date/Time departed travel status                                                          A.M. or P.M.
Number of meals provided by conference.                                                  (Do not include continental breakfast.)


HOTEL                       The original copy of the hotel bill showing $0 balance due for the room and tax only must be attached.
                            All incidental expenses, (I.e. movies, room service, personal telephone calls, etc.) must be
                            paid by the employee at check out and should not be included on the hotel bill.
Was hotel direct billed to OSU-OKC (or) did you pay hotel bill?________________________
                                                                                   Cost?
Is hotel designated conference site?                yes                    no
If hotel is not conference site, then an Employer Designated Lodging form must be attached.
An original copy of your hotel bill must be provided even if the hotel agrees to send an invoice.

MISCELLANEOUS                 Shuttle          $
EXPENSES                      Parking          $                          Please attached receipts
                              Tolls            $                          to the back of this form.
                              Other            $


MILEAGE LOG                   Mileage will be reimbursed at $0.345 per mile
Vehicle License Tag #


                                               Odometer Readings                         Departure Return
To                                             Beginning Ending               Miles        Time      Time             Purpose




PLEASE STAPLE ALL RECEIPTS, ALONG WITH COPY OF CONFERENCE BROCHURE AND AGENDA TO THE BACK
OF THIS FORM AND SUBMIT TO JANET STRICKLIN, BUSINESS OFFICE, AD201, FOR REIMBURSEMENT.
IF YOU HAVE QUESTIONS REGARDING THE COMPLETION OF THIS FORM, PLEASE CALL ME AT EXT 205.
                  of receipt or copy of cancelled check front/back.




showing $0 balance due for the room and tax only must be attached.

				
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