First M.I. Last (Please Print)
Department: Employee ID:
Campus/Site: Telephone #:
After completed, this form needs to be approved by your supervisor and then added as an attachment to your Expense Report
in PeopleSoft. This request for mileage reimbursement may not include travel outside San Diego County.
Total Number of Miles
Mileage for Month Ending Times Standard 2020 Mileage Rate/Mile
Total Amount
Claimed for Reimbursement
I hereby certify that I incurred the above mileage in the performance of my official duties, that the information given is true and
correct, that no
part of the travel was performed outside San Diego County; and I hereby present my claim for reimbursement.
Employee’s Signature__________________________________________
Date _________________
Approver’s Signature __________________________________________
Date _________________
Approver’s Name _____________________________________________
Date _________________
Fund Dept. Activity Account Amount Description
Mileage Reimbursement
Mileage Reimbursement
Information
1044 Black Mountain Road, San Diego, CA 92126-2999
MONTHLY REQUEST FOR MILEAGE REIMBURSEMENT FOR USE OF PRIVATELY OWNED CARS
(See SDCCD AP 6310.2 for Authority)
Business Purpose
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signature
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