Calendar Year 2020
Employee Name Assigned Work Location
Mailing Address Position
City State Zip Code EIN
Budget Codes(s) %
Date Miles
Round Trip?
Yes or No Starting and Ending Locations Purpose of Trip
Total Miles Mileage Rate 0.575
Parking Receipts
Total Claim
Requested by Date
Supervisor Date
Site/Department Administrator Date
Form Revision 08/2019 bg
$ 0.00
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Mileage Reimbursement Form Instructions
Employees using their own vehicles for authorized travel on school district business may be reimbursed for mileage at
the rate established by the Chief Business Officer and shall be no less than the standard rate established by the Internal
Revenue Services (IRS) for business miles, pursuant to Board Rule 3325.
The only valid mileage reimbursement form is located on the District website/Staff Portal under District Forms &
Manuals/Accounting. Processing of reimbursement requests will be delayed until all necessary information has been
1. Complete the employee information fields: Employee Name, Mailing Address, Assigned Work Location, Position
and EIN (Employee Identification Number.)
2. List the travel date(s). If you need to use two lines for multiple stops on the same date please leave the date and
miles fields blank on the second line.
3. List the total miles driven (round to the nearest whole number).
a. Use the Mileage Chart to calculate mileage from district site to district site.
b. Use MapQuest/Google Maps (not your odometer) to calculate mileage to and/or from district sites to non
district locations or home visits
4. Select “Yes” or “No” to indicate if the mileage claim is one way or round trip.
5. List the beginning and ending locations.
a. For nondistrict locations, please list the name of the entity visited, street address, city and zip code.
b. For home visits, please only list the last name of the student (for confidentiality), street address, city and zip
6. Select the purpose of the trip (Home Visit, Site Visit, Meeting or Supervision).
7. Enter the total of all parking receipts (staple the receipts to the back of your completed form).
8. If completing the form online, the total miles and total claim fields are calculated automatically.
9. Provide the budget code and percentage.
10.Print this form on white paper.
11.Sign and date the form in the requested by field; obtain Supervisor and Site/Department Administrator’s
approval; and forward to Budget for approval.
Mileage reimbursement requests must be approved by site/department administrator and Budget before they can
be processed by Accounting
Reimbursement requests should be submitted on a monthly basi s and not accumulated over several months.
Reimbursements are processed once a month
Approved mileage reimbursement requests received in Accounting by the 10
of the month will be processed that
month. Approved mileage reimbursement requests after the 10
of the month will be processed in the subsequent
If travel begins from the employee home or ends at the employee home, the reimbursement will be the lesser of the
employee home assigned work location or home. Per Board Rule 3325
Checks are mailed to employee’s home; therefore, correct mailing address must be on the mileage request form
Form Revision 08/2019 bg
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