The Annenbergschool for Communication

The AnnenbergSchool for Communication

University of Pennsylvania

FORM 16 - DISSERTATION BUDGET REQUEST

Please return the completed form to the Business Office.

Student’s Name:______

Advisor’s Name:______

Dissertation Title:______

Please read the research policy on the following page. You must comply with the entire policyto remain eligible for reimbursement.

List below (in detail) your anticipated expenses.

CategoryExplanationAmount

(e.g., travel)(e.g., 4 round trips)

______

______

______

______

______

______

______

TOTAL REQUEST______

TOTAL APPROVED______

______

Signature of StudentSignature of Advisor

FORM 16 - DISSERTATION BUDGET REQUEST

Rules for Reimbursement

1)Doctoral candidates can apply for a dissertation budget of up to $1,200.

2)Only expenses incurred while performing research related to the dissertation are eligible for reimbursement.

3)Only expenses incurred AFTER the budget has been approved will be considered for reimbursement.

4)Eligible candidates should submit a request for a dissertation budget as soon possible after the dissertation proposal has been accepted by the Dissertation Committee.

5)Candidates requesting funds for payments to individuals (such as coders, study participants,etc.) must discuss these plans with the Business Administrator when submitted the budget for approval.

6)Receipts must be submitted for all expenses through Concur.

7)Candidates must initially pay all dissertation expenses out of pocket and be reimbursed as you receive the expenses.

8)Reimbursement will be made for the lowest possible airfare, train fare, or mileage, and if student’s annual travel budget permits, for room and tax changes for hotel accommodation. Submit original receipts (see below) to the Business Administrator within 10 days of the conclusion of the trip.

9)Insurance costs for rental cars will NOT be reimbursed, as they are covered under the University’s self-insurance plan. You must attend the University’s Drivers Safety Program to be eligible for this coverage. If you have not, the University will not be responsible should an accident occur, nor will the University reimburse you for the cost of insurance.

By signing below, I certify that the expenditures submitted were incurred by me while on official business in the city or cities indicated above. Further, this form certifies that I was insured for at least the statutory minimum for bodily injury and property damage for any automobile rental charges for which I seek reimbursement.

Total Value of Original Receipts $______

Total remaining in dissertation budget after these expenses are reimbursed:

______

If this expense is being charged to a budget other than your personal travel/research budget or dissertation budget please indicate the name of the other funding source below and attach any approval documentation with the receipts.

Name of Student

______

Signature of StudentDate

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