TRAVEL EXPENSE REPORT
CODING
Travel Expense Amount
Dept ID
Travel Policies
[For travel after 10/4/15]
`
CLAIMANT INFORMATION
Project ID
Acct
CONTACT INFORMATION
Last Name
First Name
Pointer
Stevie
Select:
UWSP Employee
State Emp
M.I.
Non-state employee
Contact Name: Stevie Pointer
Contact Email: spoint@uwsp.edu
Contact Phone: 555-555-5555
From (Originating City/State) - To (Destination City/State): Dates of Travel
Student
Home or Campus Mail Address
Explain business purpose of trip - Explanations, Justifications, Cost Comparisons
CPS
UWSP
-
Total Travel Expense Amount
Travel Advance to Repay
-
Email address
Agency Name & Headquarter City
spoint@uwsp.edu
Employee Payroll ID (8 digits)
UWSP
Student ID #
Tvl Adv Dep't ID & Acc't
021601
021601
6166
6166
Net Amount
M / D / Y of

Personal
Travel
for
Vehicle
Expense
Fleet
Miles
12/25/15
38
12345678
* Pro-Travel Cardholder Name:
Travel Expense Amount in US $
Describe/Explain Travel Expense (air, hotel, rental car, registration, etc.)
Enter Meals in Appropriate Columns 
Provide additional city/state destinations
Prepaid
* PT Card
T Card


Hosted
Meals
Cash/Other
Day Trip Meal
Allowance
M & IE Per
Diem
Allowance
Total Expenses
Wausau East - Supervision of Jane Doe
-
12/26/15
X
Madison West - Supervision of Bucky Badger
15.00
15.00
Madison West - Supervision of Bucky Badger
15.00
15.00
1/1/16
116
-
Total Pers. Miles
154
Totals
I certify claim(s) being submitted are: Actual costs personally incurred net of any expenses provided or covered by other
sources. Business related and support missions of my unit, UW or the State. Allowable and in compliance with all
policies, regulations and limits. Supported by required receipts, documentation or other additional justifications when
required. Allowable and appropriate for funding source(s) indicated. I am aware of consequences for fraudulent
unethical claims, including: Intentionally falsifying or filing a fraudulent claim is considered to be a class C felony in WI
Statues 939.50(3), for which penalty is a fine not to exceed $10,000 or imprisonment not to exceed two years or both. I
am accountable for the claim(s) being submitted and accept responsibility to justify any costs or claims subject to review
or scrutiny by: Federal, State or University officials and auditors: State taxpayers, interested public and media outlets;
Sponsors of funds.
-
-
-
-
PERSONAL VEHICLE MILEAGE CALCULATION
Date
Supervisor Approval Signature:
Print Name 
Date:
-
30.00
Expenses: $
30.00
Mileage: $
62.68
92.68
100 Miles or less

38
Miles at
$ 0.575 per mile =
$
21.85
Over 100 Miles

116
Miles at
$ 0.352 per mile =
$
40.83
Total
Reimbursable $
$
62.68
Travel Budget
Limited to:
Travel Total: $
Prpd & PT Amount $
Total:
Office Phone #
I certify that I have reviewed this travel claim and find it to be reasonable and in compliance with established travel
policy and the mission of the department. [Supervisor Signature Required]
30.00
TOTALS AND LIMITATIONS
Distance traveled per round trip:
Rates effective October 5, 2015
Claimant's Signature
-
I certify that I have reviewed this travel claim and find it to be reasonable and in compliance with
established travel policy and the mission of the department.
Dean, Director, Budget or Other Approval Signature as Required
by School, College or Division Policy
Date:
92.68
I certify that this document has been audited for
compliance with provisions of the UW System Travel
Policies.
Institution Pre-Audit Approval
Updated 10/29/15
Date: