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Travel Expense Report (In-State Long Form)
Phone Number (10 digits):
Depart Return Description Amount
Advance
Registration
Other
(listinnotes
below)
Vice President's Printed Name (if required) Date
Supervisor's Printed Name
Date
Traveler'sSignature Date
TOTALTRAVELEXPENSES
LESSADVANCERECEIVEDAND/OREXPENSESPREPAIDBYUNIVERSITY THAT ARE CLAIMED ABOVE
PublicTransportation
(Air,Bus,Train,etc.)
PerDiem
OtherExpense
DailyExpense
From
To
Date
mm/dd/yyyy
Time
(DayTripsOnly)
Location(City)
Mileage
Rate
(updated
annually)
Mileage
ReimbAmt
Email Address:
INSTRUCTIONS:
Fillouteachapplicablesection.Handwritten,incomplete,orunsigned/datedformswillbereturned.
TravelSummary(mustincludepurpose,
location(s),anddaterange)
COMPTROLLER'S OFFICE
Name of Traveler: Encumbrance & FOAP:
Traveler Vendor A-Number: School/Div & Dept:
COFORM‐REVISED 01/18/19
Other Approver's Printed Name (if required) Date
Vice President's Signature (if required) Date
Other Approver's Signature (if required) Date
Supervisor's Signature Date