International Travel Application

New   Supplement   Revised
Contact:
Phone:   M/S:

Traveler’s Name:   Group Leader:   Volunteer:   Student:
Home Address: ,
Employee ID:   Department:
Cell Phone:   Email:

TRAVEL ITINERARY

Destination(s):
Purpose of Trip:
Date(s): Departing:   Hour:   Returning:   Hour:

ESTIMATED TRAVEL EXPENSES

Train   State Car   Rental Vehicle   Plane   (Direct Bill)
Privately Owned Vehicle (Authorization form must be on file)
International Insurance Fee $60.00 (Mandatory)   60.00
Maximum Federal Per Diem Rate (includes lodging, meals and incidentals)
Other:
Total $

Enrolled in STEP (https://travelregisttration.state.gov)   (applicant’s initials)

State contract rates have been used where available

If trip is to be reimbursed by other funds/agency, enter name of agency:

TRAVEL EXPENSES

REQUEST FOR PAYMENT / REIMBURSEMENT

Payment Request: ______ (Attach Inv or Reg Form)   Reimbursement Request: ______ (Attach Receipt)

Payable to:   Mail check by (date):
Remit address: ,   Payment Amount:

ADVANCE - FOR GROUP / STUDENT TRAVEL ONLY

Advance requested in amount of $   to be paid by (date)

APPROVING SIGNATURES

Applicant’s Signature:   Date   Applicant’s Report to:   Date

Dean/Director (if applicable)   Date   Authorized Signature for Dept ID#   Date

Provost/VP (if applicable)   Date   President (if applicable)   Date

Please note that travel to a high hazard or area with an active US State Department travel warning requires campus President approval 30 days in advance, and travel to War Risk locations requires campus President and Chancellor approval. Notify the campus Risk Manager at 278-7422 ASAP to help facilitate approval process.

Download the PDF

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