TRAVEL REIMBURSEMENT REQUEST
Traveler:
____________________________________________________
Address:
Social Security (for students) or Employee ID # (for employees):
Account name or alias to be charged:
Funding source approver signature: ___________________________________
Date/Time of Departure:
_____
Destination:
Date/Time of Return:
Cost of tickets: _________________________
Purpose of Travel:
Required: If you attended a conference/workshop, please ATTACH a conference/workshop
ANNOUNCEMENT (usually from the website) which includes the date/time/location. If you
attended a meeting, consultation or collaboration, attach an announcement or an email from the
meeting organizer that includes date/time/location and purpose of the meeting.
Miles driven in Private Car:
Rental car, Taxi, Shuttle Costs (ATTACH RECEIPTS):
______
(For Rental Car, rental agreement REQUIRED)
Meal Costs (ATTACH RECEIPTS): Total: ________
(Itemized receipts that show meal items REQUIRED):
OR
Per Diem: # of Breakfasts
# of Lunches
# of Dinners
(For per diem reimbursement, attach a full schedule to show which meals were included in the meeting or
conference)
Parking (ATTACH RECEIPTS):
Registration Fee (ATTACH RECEIPT):
Lodging (ATTACH RECEIPTS):
Other Expenses (Please Explain)
Did You Receive a Travel Advance?
If so, how much?