Travel Authorization Request
Conference Date/Time:
Begins Hr: Mi: AM/PM
Ends Hr: Mi: AM/PM
Trip Date/Time:
Begins
Ends
Hr: Mi: AM/PM
Hr: Mi: AM/PM
Destination:
Purpose:
W Number(s)
TA Expenses
No. of Miles
Amount Amount
Amount Amount
Amount Amount
Amount
Include all expenses, including any expenses listed on a travel grant application. It is also better to over-estimate some costs.
Category: MILEAGE
Amount
Category: AIRFARE
OFFICE USE ONLY
Reimbursable only if purchased through Carlson Wagonlit Travel Agency 1-888-239-1755
Category: LODGING
Estimate cost to include taxes
Category: MEALS
Category: REGISTRATION
Amount
Category: TRANSPORTATION
Amount
Circle One: SHUTTLE TAXI OTHER (i.e. subway, bus, etc.)
Amount
Category: PARKING
Amount Amount
Attach round-trip mileage calculation from Yahoo Maps or Mapquest.com
Category: MISC
Amount Amount
Revised 09/2009
TA No
Account
Budget
Amount
Budget
Budget
Amount
Amount
Approved
Denied
Cancelled
OFFICE USE ONLY
Description:
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