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) ________________________________________________
Lodging __________________________________________________________________________________
Meals / Incidentals (Max. $55.00/day + $7.00/day incidentals) Itemized receipts required for meals ____________________
Registration __________________________________________________________________________________
Other: __________________________________________________________________________________
Total $ ____________________ 60.00
State contract rates have been used where available ____________________ (applicant’s initials)
If trip is to be reimbursed by other funds/agency, enter name of agency: ____________________
TRAVEL EXPENSES
| Travel Claim Reimbursement | Account | Fund | Department | Program | Class | Project |
|---|---|---|---|---|---|---|
REQUEST FOR PAYMENT / REIMBURSEMENT
Payment Request: ______ (Attach Inv or Reg Form) Reimbursement Request: ______ (Attach Receipt)
| Amount | Account | Fund | Department | Program | Class | Project |
|---|---|---|---|---|---|---|
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
Travel Expense Claims are due in the Accounting office no later than 30 days from the trip return date.
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