OUT-OF-STATE PRELIMINARY INFORMATION
(TO BE FILLED OUT BEFORE TRIP)
______
NAME OF TRAVELER:
TITLE: SOCIAL SECURITY #:
DESTINATION:______
PURPOSE OF TRIP:______
am
DEPARTURE DATE:______ESTIMATED TIME OF DEPARTURE:______pm
am
RETURN DATE:______ESTIMATED TIME OF RETURN:______pm
FUND NUMBER TO BE CHARGED:
PER DIEM:______DAY(S) AT $______/DAY TOTAL PER DIEM $______
(If you wish to claim less than per diem rate, write in the amount you will be claiming)
AIRFARE: q Paid in advance by Traveler------$______
q Charged at Travel Agency
List Travel Agency:______
(EVEN IF YOUR AIRFARE WAS PAID BY THE UNIVERSITY, YOU WILL NEED TO TURN IN THE PASSENGER’S RECEIPT OF THE TICKET)
AUTO: Personal Vehicle:______miles @ $ .345/mile------$______
(Odometer readings must be turned in after you return)
AIRPORT PARKING------$______
REGISTRATION FEE: q Includes Optional Meals------$______
q Includes Lodging
TAXI FARE------$______
OTHER:______$______
______$______
______$______
TOTAL $
______
If you are traveling to a meeting, you must submit a copy of something from the organization with the dates of the meeting on it before this form can be processed.
Receipts for all items other that per diem (food & lodging) must be turned in for reimbursement. You will not be reimbursed without them.
Planning on driving instead of flying? You will only be able to claim cost of airfare (get quote from travel agent) unless you have a good reason for driving (collecting field samples, picking up equipment, etc.)
REIMBURSEMENT FORM
(TO BE FILLED AFTER TRIP)
______
NAME OF TRAVELER:
TITLE: SOCIAL SECURITY #:
DESTINATION:______
PURPOSE OF TRIP:______
am
DEPARTURE DATE:______ESTIMATED TIME OF DEPARTURE:______pm
am
RETURN DATE:______ESTIMATED TIME OF RETURN:______pm
FUND NUMBER TO BE CHARGED:
PER DIEM:______DAY(S) AT $______/DAY TOTAL PER DIEM $______
(If you wish to claim less than per diem rate, write in the amount you will be claiming)
AIRFARE: q Paid in advance by Traveler------$______
q Charged at Travel Agency
List Travel Agency:______
(EVEN IF YOUR AIRFARE WAS PAID BY THE UNIVERSITY, YOU WILL NEED TO TURN IN THE PASSENGER’S RECEIPT OF THE TICKET)
AUTO: Personal Vehicle:______miles @ $ .345/mile------$______
(Odometer readings must be turned in after you return)
AIRPORT PARKING------$______
REGISTRATION FEE: q Includes Optional Meals------$______
q Includes Lodging
TAXI FARE------$______
OTHER:______$______
______$______
______$______
TOTAL $
______
Receipts for all items other that per diem (food & lodging) must be turned in for reimbursement. You will not be reimbursed without them.