MILEAGE
DATE BREAKFAST LUNCH DINNER NUMBER AMOUNT HOTEL REGISTRATION CAR RENTAL TRAVEL PARKING TOTAL
SAN BERNARDINO COMMUNITY COLLEGE DISTRICT
TRAVEL CLAIM FORM
I hereby certify that the amount requested is for reim-
bursable travel expense necessary in attending to District
business. Advance shall be repaid or adjusted upon filing
of Part C below within thirty (30) days of event. If the travel
is cancelled, advance will be returned to Fiscal Services
within 3 days from date of cancellation. Failure on my part
to return the advance gives automatic authorization for the
Payroll Dept. to deduct the advance from my payroll check.
___________________________________ ________________
Requestor Date
Accounting Office Use Only
Warrant # ________________ Amount _________________
Date Issued ______________ P.O. # ___________________
_________________________________________________ ______________
Responsibility Center Manager Date
_________________________________________________ ______________
Administrator/President Date
_________________________________________________ ______________
Chancellor Date
Estimated Cash Expenditures: Amount PO Number
Travel (airfare, mileage) $ _________________ _________________
Hotel $ _________________ _________________
Meals $ _________________ _________________
Registration $ _________________ _________________
Miscellaneous (parking,
shuttle, taxi, etc.) $ _________________ _________________
Total Estimated $ _________________ _________________
Advance Request at 80% $ _________________ _________________
PART B: ADVANCE REQUEST - COMPLETE PART B ONLY IF REQUESTING AN ADVANCE
Date of Board meeting Approving Event _____________________
NAME OF EMPLOYEE: (Please Type or Print) _____________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Name of Conference, Meeting, Etc.
_______________________________________ from __________________________ 20 _______ to ______________________________ 20 _____
City & State
1. Total Travel Expenses ___________________________
2. Deduct advance (from Part B) ___________________________
3. Net claimed (1 greater than 2) ___________________________
4. Amount remitted if 2 is greater than 1. Include check payable to San Bernardino Community College District ___________________________
I certify that the above are actual and necessary expenses incurred in accordance with the provisions of Education Code Sections 87032.
I further certify that the above expenses were for the benefit of the claimant only.
___________________________________________________________________________________ Date _______________________
Claimant's Signature
Approvals:
Responsibility Center ______________________________________________ Date: _______________________
President _________________________________________________________ Date: _______________________
P.O. ___________________
Amt. ___________________
Note: If travel requires board approval, advance request will not be processed until travel is approved by the Board of Trustees.
Please attach Conference Literature & Hotel Information.
PART C: EXPENSE REPORT - COMPLETE THIS PART WHEN TRIP/EVENT IS COMPLETED
Conference Literature Required
Original Receipts Required for All Claims except mileage (exclude all tips)
AC-10 Updated 11-08 DISTRICT OFFICE
TOTAL
PART A: GENERAL DATA
