In-State/Out-Of-State Travel Expense Form

Received:______

IN-STATE/OUT-OF-STATE TRAVEL EXPENSE Matrix:______

REIMBURSEMENT REQUEST SpreadSht:______

Name:School:

(Please Type/Print)

Employee Number:

Home Address:

Purpose of Trip:

Date of Trip:Location:

Itemized Expenses: (See Travel Policy on back)

Expenses may be deducted from several accounts. Expenses may be deducted from several accounts.

ANTICIPATED EXPENSES:ACTUAL EXPENSES:

Acct #:Acct #:

Transportation ($.31/mile)$Transportation ($.31/mile)$

(See back for instructions)(See back for instructions)

Lodging:$Lodging:$

*Meals:$*Meals:$

**Registration Fee:$**Registration Fee:$

Other Expenses:$Other Expenses:$

(See back for instructions)(See back for instructions)

AMOUNT REQUESTED:$

TOTAL EXPENSES:$

(Receipts should be attached.

AMOUNT APPROVED:$

TOTAL REIMBURSEMENT:$

* General Laws, Chapter 44, Section 58 restrictions apply.Make a copy of this form for your files.

Meals: ($35/day average; no alcoholic beverages-itemized receipts)

**Copy of registration form and proof-of-payment must be included.

Applicant’s Signature: Date:

Principal/Supervisor’s Approval: Date:

Central Staff Pre-Approval Signature:______Date:

FINAL Approval:Date:

Assistant Superintendent for Teaching and Learning

FORMS MUST BE RETURNED WITHIN THIRTY (30) DAYS OF THE EVENT TO:

Newton Public Schools, Office of Teaching & Learning, Room 215, Education Center

IN/OUT Form: Revised: 12/12/13

In-State/Out-of-State Travel Policy

It is the policy of the Newton Public Schools to encourage and support the professional development activities of its staff members and their attendance at various regional and national conferences. If possible, an amount of money will be available in the school system budget each year to support out-of-state travel, subject to the out-of-state travel procedures developed by the Central Staff and monitored by the Assistant Superintendent for Teaching and Learning. Please print out on BLUE paper.

Process and Procedures

Individuals applying for In-State/Out-of-State Travel must:

1.Seek Pre-Approval for anticipated expenses using the form on the reverse side. Present this estimate to his/her respective Principal/Supervisor or Central Staff Administrator for the identification of funding sources, and approval.

2.Forward the pre-approval form to the Office of Teaching & Learning for a pre-approval signature.

3. Transportation:

Auto: (.31 cents per mile). Destination:______

Start Mileage______End mileage:______

.31 cents x ______miles = TOTAL MILEAGE EXPENSE ______

Tolls & Parking: Submit original receipts.

Air and Train: Submit original receipts and/or original tickets, etc.

4.Meals:

Average per diem $35.00.

Alcoholic beverages are not reimbursable. General Laws, Chapter 44, Section 58, restrictions apply. Please submit all original receipts that do not include costs for alcoholic beverages.

5.Lodging:

Every effort should be made to secure the most cost effective accommodations appropriate to the setting and purpose of the trip.

6. Reimbursement Process:

After the trip, re-submit the pre-approved In-State/Out-of-State Travel Form (blue form). List actual

expenses.

7.Submit all original receipts to the Office of Teaching & Learning.

8.Reimbursement should not exceed pre-approved amount/accounts originally identified.

9.In-State/Out-of-State travel forms will be sent to Accounts Payable following final approval by theOffice of Teaching & Learning.

10. Make a copy of this form for your files.