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CALCASA
Travel Stipend Application
California Coalition Against Sexual Assault is offering travel stipends to assist you in participating in
the following volunteer trainings: (Please check all that apply to you)
Executive Director’s Training and Meeting @ Sheraton Grand Sacramento
June 14, 2011 (10:00 am – 5:30 pm) & June 15, 2011(8:30 am – 3:30 pm)
Travel stipends are available for this event. In order to be eligible for a stipend you must complete
this document and submit it to Kavin Black via fax at (916) 466-8166 or email [email protected] by
June10, 2011.
Stipend awarded amounts are based on certain requirements and qualifications, as described in the
Travel Stipend Application Guidelines. Awards are issued in the form of a check reimbursement,
not a cash advance. The amount of the travel stipend is based on your estimated expenses to attend
the training(s). Approved amounts are non-negotiable.
I) Application Information:
Attendees Full Name:
_________________________________________
Name of Agency or Rape Prevention Program: __________________________________________
Agency Address __________________________________________________________________
Your Title ____________________________________
Contact Phone Number: __
____
Fax Number: ______
___
Email address: _________________________________________________________________
Reimbursement check made payable to:: ______________________________________________
Payment reimbursement mailing address _______________________________________________
________________________________________________________________________________
Stipends: Volunteer Trainings 2011
1
Only staff from California rape crisis centers are eligible for travel stipend reimbursements.
II.
Eligible Items for Reimbursement
.
1. Travel Expenses: We ask that participants find the most economical form of travel.
 Airfare or Train fare (within California only) including baggage fees (1 bags maximum) not
exceeding the airline’s weight requirements. If you require air travel you will book it through
our designated travel agency: Giselle’s Travel. Once all signatures on this form are
obtained you will receive the contact information for Giselle’s Travel.
 Hotel / Airport parking (non-valet only);
 Airport shuttle or ground travel to/from the hotel (no rental cars or fuel/gas costs allowed);
 Mileage at $0.50 per mile: Round trip mileage from office to conference site (Google
map documentation will be required for verification purposes)
 Lodging at the California Government rate per /night plus applicable taxes (approximately
$110 plus tax). Lodging is only available for attendees whose office is more than 50 miles from
the conference site per California government guidelines. Once all signatures on this form are
obtained you will receive the contact information for lodging along with conference code.
 Per diem at a maximum of $40 per day per state government guidelines - receipts are NOT
required for per diem. Per California government travel guidelines, no per diem costs are
allowed if your travel time to the conference is less than 24 hours.
Items that are NOT Eligible for Reimbursements



Valet Parking
No rental cars or direct fuel/gasoline expenses are allowed.
No sightseeing, recreational, or non-conference related travel expenses
PLEASE REMEMBER: Receipts are required for all expenses except for per diem costs.
Reimbursement forms will be distributed upon approval of the scholarship via email and must be
submitted at the conclusion of the event with all applicable receipts for reimbursements by July 15,
2011 in order to be eligible for reimbursement. No late forms will be accepted or eligible for
reimbursements.
Please submit your travel stipend application to [email protected] or by fax at (916) 446-8166. For
questions regarding this training and or reimbursements, please contact the following person:
Kavin Black
[email protected]
Stipends: Volunteer Trainings 2011
916.446-2520 x305
2
III) Estimated Training Expenses - Only staff from California rape crisis centers are eligible for reimbursements.
Attendee’s Name ____________________________________________________________
Name of Agency or Rape Prevention Program: _______________________________________
V
Travel Start Date and Time ____________________
Travel End Date and Time ____________________
Eligible Items for scholarship consideration
Ve
a) Mileage (roundtrip):
Estimated Total
Cost
CALCASA
Approved Amt.
Total Estimate
Total Approved
$0.50 x # of miles _________
Attach a map printout-i.e. Google, MapQuest, etc.- to verify miles to and from your office)
b) Airfare /Train fare (within California only) - include baggage fees for maximum 2 bags (Receipts required)
c) Parking: # of days ________ x $ ________ /day
(Sheraton Grand Sacramento Parking is $12 per day)
(Receipts required)
d) Airport Shuttle / Ground transportation (to and from hotel)
(Receipts required)
e) Lodging: # of nights (include dates) ____________________________ x /night ($84 single / $134
double nightly rate + approx. $20/night in taxes and fees)
 Rates at the Sheraton Grand Hotel are set at the California government rate of $84 single/ $134 double night plus
applicable taxes and fees (approximately $20/night). Receipts required
 Note: Lodging only available for attendees traveling more than 50 miles one way from their office.
f) Per diem at the California government rate: (Depends on travel time) # of days _________
receipts required).
(No
Per diem is not allowed if travel time is less than 24 hours per state government guidelines.
g) Other Charges (i.e. toll charges)
Final Total Cost
Stipends: Volunteer Trainings 2011
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IV. Signature Page
To Be Completed by CALCASA Staff:
Amount Requested: $__________
Amount Approved/Awarded: $________
CALCASA Staff Only: Review of stipend application
__________________________________
Signature
Stipend Not Approved_______
______________________
Date
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Acceptance of Stipend:
I understand that the scholarship amount of $___________ has been approved by CALCASA and is non-negotiable. I accept the
scholarship based on the approved amount and understand/agree to all the terms noted in the scholarship guidelines. I also
understand that my scholarship will be reimbursed by CALCASA based on my expense reimbursement forms submitted with the
proper receipts to CALCASA by indicated dates.
Recipient’s acceptance of approved Scholarship
Amount by CALCASA
__________________________________
Signature
______________________
Date
Stipend awarded amount is not valid until this form is received by CALCASA with appropriate and completed signatures.
After review and signature, please return to CALCASA within 1 business day to complete processing of your scholarship award.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Non-Acceptance/Declining Stipend Award:
I hereby decline the stipend award.
Stipends: Volunteer Trainings 2011
__________________________________
Signature
4
________________________
Date
Download

Reimbursement Form