REQUEST FOR FACULTY CANDIDATE REIMBURSEMENT
SECTION I - COMPLETED AND SIGNED BY THE CANDIDATE
NAME OF CANDIDATE
EMPL ID# (if applicable)
HOME ADDRESS:
(City) (State) (Zip
Code)
Is the Payee or
beneficiary of the payment a U.S. Citizen or a Permanent Resident Alien?
YES NO
If “NO,” please provide email address:
POSITION APPLIE
D FOR: DATE(S) OF INTERVIEW:
DEPARTMENT
ITEMIZE EXPENSES – Receipts are required for meals, auto mileage (attach mapquest) , or tips. Boarding passes are required for
air flights (including ticketless flights), and receipts are required for all other expenses:
LODGING $ (single occupancy) TRANSPORTATION $
(Lodging at the Towson University Marriott Conf. Hotel (Coach / Tourist/ Personal Auto @ 58 cents/ mile;
Taxi;
is billed directly to the University) Rental Car)
MEALS $ MISC
ELLANEOUS $
(Not to exceed $46 day)
TOTAL $
_____________________________________
___ ____________________________
CANDIDATE’S SIGNATURE DATE
CANDIDATE: Please forward this completed form and any required receipts to the Department/Search Chairperson @ Towson University,
8000 York Road, Towson, MD 21252. Thank you.
SECTION II – COMPLETED BY THE DEPARTMENT/SEARCH CHAIRPERSON
SEARCH NUMBE
R_________________________ DEPARTMENT_______________________________________
APPROVED: ___________________________________________ ______________________
DEPARTMENT OR SEARCH CHAIR‘S SIGNATURE DATE
Please forward to the Provost’s Budget Office for processing. Thank you.
SECTION III - COMPLETED BY THE PROVOST’S BUDGET OFFICE
AMOUNT TO BE REIMBURSED_________________________ DEPARTMENT/ACCOUNT: 16810 604017
APPROVED: _________
____________________________________________ ______________________
DATE
Division of Academic Affairs
Academic Resources and Planning
Administration Building, 3rd Floor
**Please attach a completed W9 to this request**
click to sign
signature
click to edit
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