Fillable CCSU TRAVEL AUTHORIZATION 6/05

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CCSU TRAVEL AUTHORIZATION 6/05

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CSU TRAVEL AUTHORIZATION
CENTRAL CONNECTICUT STATE UNIVERSITY
CSUFRS - 30 (6/05)
1615 STANLEY STREET
NEW BRITAIN,
CT 06050
1. Use this form for all travel; all requests must be typewritten
_____Original TA _____Revised TA
2. Forward to Business/Travel Office with attached Documentation
T.A. No. T__________________
3. Sanditz Travel: 346-5511 DATE OF REQUEST:
CCSU ID #
EMPLOYEE NAME: WORK PHONE/EXT: HOME PHONE:
TITLE:
OFFICIAL DUTY STATION:
COLLECTIVE BARGAINING UNIT: ___AAUP ___MGMT ___SUOAF-AFSCME ___OTHER_______________________________
ITINERARY
HOME/DUTY STATION TO
DEPART
DATE HOUR
RETURN
DATE HOUR
CARRIER INFOR
Flight/Rail/Bus
OBJECT AND NECESSITY OF TRAVEL (Attach substantiating documents)
___01 Paper Presentation
___03 Research ___05 Team Travel ___07 Faculty Development ___09 Other Activities (Describe)
___02 Conf./Workshop
___04 Recruiting (Athletics) ___06 Training ___08 Univ. Development ___99 Other (Describe)
TYPE OF TRANSPORTATION
___AIR (___Sandtiz ___Outside Agent ____P Card Purchase)
___PERSONALLY OWNED CAR (Current Copy of Insurance Policy req.)
EXP. DATE____
___RAIL (___Sandtiz ___Outside Agent ___P Card Purchase)
___STATE OWNED CAR
___OTHER (Specify)____________
___PARKING PERMIT REQUESTED
NAMES OF RIDERS
:______________________________________
Registration Prepaid by Agency: ___Yes Vendor's FEIN # (MANDATORY) _______________________ Voucher No.: __________
Registration P Card Paid _____ Amount Charged on P Card__________._______
* AGREEMENT ON REVERSE MUST BE SIGNED*
Travel Advance Requested: ___ Amount Requested: $____________. ______
Total Cost (Itemize) Note: Rates for meals and lodging should not exceed those provided for in standard Travel Reservations and in Collective Bargaining Agreements.
___Airfare/Rail
$____________.__ ___ Lodging (Per Diem Rate $____) $______________.___
___Taxi/Limo
$____________.__
___ Conference Hotel
$______________.___
___Rental Car
$____________.__
___ Hotel Tax
$______________.___
Personal Mileage___MI@___Rate
$____________.__ ___Meals (Per Diem Rate $ _____) $______________.___
Parking/Toll
$____________.__
___ Registration
$______________.___
___Other (specify)
$____________.__
TOTAL COST
$______________.___
Account Sub-Code Amount Auth. Signature
___________
___________ $__________ ___________
___________ ___________ $__________ ___________
Account Sub-Code Amount Auth.
Signature
___________ ___________ $__________ ___________
___________ ___________ $__________ ___________
Employee Signature:
__________________________________
______
Date: _________________________
Approved By: (Supervisor)
__________________________________
______
Date: _________________________
Approved By: (Dean/Dir)
________________________________________
Date: _________________________
Authorized By: (Agency Head)
__________________________________
______
Date: _________________________
Travel Office Approval/Data Entered By
__________________________________
______
Date: _________________________
TRAVEL ADVANCE AGREEMENT
In consideration for receiving a Central Connecticut State University (CCSU) check or the direct
deposit ACH (Automated Clearing House) which represents an advance against travel expenses, I
agree that these are State of Connecticut funds and understand that I am personally responsible
for them whether my employment continues or is terminated by the State of Connecticut of the
funds are lost or stolen. I agree to notify the CCSU Police and the CCSU Director of Business
Services immediately should a loss, theft, or disappearance or funds occur.
Within fifteen [15] business days of my return, I will submit a completed Request for
Reimbursement of Expenses (CO-17XP), with required documentation, to the Travel Office. I
understand that if I do not adhere to these required time frames for paperwork completion or
repayment, I may be denied future advances for travel expenses, or the repayment of my travel
advance may be deducted from my paycheck. Any failure on my part to file the required forms or
repay any advance amount by the due date will subject me to reasonable costs of collection
including, but not limited to attorney fees and court costs if required to enforced this agreement.
If the travel advance was MORE THAN the total expenditure, I will return the excess to the Travel
Office within fifteen [15] business days of my return. The travel advance receivables account will
be credited appropriately by the Travel Office.
If the travel advance was LESS THEN the total approve expenditure, the travel advance
receivables account will be credited appropriately by the Travel Office and a check or direct
deposit will be provided to me for the reimbursement due.
_____________________________________________________
Signature Date
FOR TRAVEL OFFICE USE
ONLY:
Voucher No:
_____________________
Amount Received:
_________________
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CCSU TRAVEL AUTHORIZATION 605

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Completed 18 January 2020

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