For Accounting Use Only

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FOR ACCOUNTING USE ONLY

CERRITOS COMMUNITY COLLEGE DISTRICT

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INPUT DATE

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CONFERENCE and TRAVEL REQUEST/EXPENSE CLAIM FORM

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AMOUNT

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A separate request must be submitted for EACH PERSON and EACH TRIP.

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DOC #

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A / EMPLOYEE AND CONFERENCE INFORMATION
EMPLOYEE NAME: / EXTENSION: / DEPT:
CONFERENCE NAME:
CONFERENCE LOCATION: / DATES:
Full Time Faculty / Classified / No Cost to District
Part-Time Faculty / Management / Board of Trustees
B / CONFERENCE AND TRAVEL REQUEST
Commercial Airline / Lodging / District Vehicle / Private Automobile
Automobile Rental / Meals / Mileage / Registration / Requisition No.
Other (itemize)
Account(s) To Be Charged / Percentage / Total Cost Not to Exceed
Account No: / . 5210 / % / $
Account No: / . 5210 / % / $

I recommend approval of the above request. To the best of my knowledge, expenses will not exceed available funds.

Approved:
Requestor (Employee Signature) Date / Vice President Date
Approved: Immediate Manager Date / Special Approval: / President or Designee Date
C / CONFERENCE AND TRAVEL EXPENSE CLAIM (This section is to be completed after attending the conference)
EXPENSES / Date: / Date: / Date: / Date: / Date: /

Total

Registration
Lodging
Meals: Breakfast
Lunch
Dinner
Parking
Taxi/ Shuttle
Transportation(Airfare,Train,Bus)
Other– Refer to Board Policy
Mileage* (total miles per day) *Mileage rate is 55.5 cents per mile.
Itemized original receipts must support all claims for personal reimbursement. Total Personal Reimbursement / $
This is to certify that the above expenses were incurred without personal profit.
Employee’s Signature: / Date:
Manager’s Signature: / Date:
President or Designee Approval: / Date:

See Instructions August 2011

INSTRUCTIONS

For completing the Conference and

Travel Request/Expense Claim Form

Step 1. Complete Section A – Employee Information

The information submitted here is used to verify that the employee is eligible to attend the conference.

Step 2. Complete Section B – Conference and Travel Request

This portion of the form is used to request conference attendance.

A.  After completing Section B print one original copy and submit the request to your immediate manager and appropriate vice president for approval. Requests for travel with expenses exceeding $1,000 must also be approved by the President. This request should be done at least 30 days prior to your departure date.

B.  Upon the approval of your immediate manager, appropriate vice president and President (if over $1,000), make a copy of the signed original form. The copy of the original form will be used at a later date to claim your travel expenses.

C.  Submit the original Request/Claim Form, along with the conference agenda, to Accounts Payable in the Fiscal Services Office and submit one online requisition containing the following information:

1. Conference Registration

2. Hotel Information

3. Airfare

4. Car Rental

Step 3. Complete Section C – Conference and Travel Expense Claim

This portion of the form is used to claim reimbursement for expenses incurred while you were attending the conference which have not been paid by the District.

A. Upon returning from the conference, immediately complete Section C on the copy of the original form that you retained. This must be submitted within 30 days of your return.

B.  List all actual and necessary expenditures incurred that were not paid by the District.

If there is no claim for reimbursement, write none or “0” in the space provided for Total Claim, sign and submit the form to Accounts Payable in the Fiscal Services Office. Checks should be issued within ten (10) calendar days. The Accounting staff will notify you by phone when the reimbursement check is available to be picked up at the fee payment window located in the Administration Building.