Discretionary In-State Travel Individual Request

Program

Discretionary In-State Travel Individual Request

Discretionary Criteria (check ONE):

☐ Conference

☐ Meeting

☐ Seminar

☐ Professional Development Course

☐ Networking Opportunity

☐ Continuing Education Classes/Seminars

Title of Event:

Dates of Travel:

Purpose:

Benefit to the State:

Number of Trips:

Destination:

Projected Cost: Total Cost

Approx. Cost
per Trip / Number of Trips
3
*Flight – Sacramento to Oregon / $256.00 / $768.00
Two Day Vehicle Rental – Vehicle Description / $180.00 / $540.00
Fuel:
(700 miles @ 20mpg x $4/gal) / $140.00 / $420.00
Lodging: / $90.00 / $270.00
Meals: / $41.00 / $123.00
Incidentals: / $5.00 / $15.00
Total Cost / $471.00 / $1,413.00

*Provide a print screen of the non-refundable airfare rate from the Concur website as backup.

Source of Funding (Must use fund name as shown in the Governor’s Budget):

Number of Travelers and the Role of Each Traveler:

Impact if Trip is Denied:

Impact of the traveler’s absence on regularly assigned duties: