CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Business Services
Conference Leave: Expense Claim Form
Name:
Address:
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Claim forms must be received by the Business Office no later than the tenth day of the
month folowing the month in which the conference was attended.
Complete all appropriate items. If additional space is required, use additional forms. Refer to
Board Policy 4070 for procedure governing submission of claims.
1. Receipts must be attached for all expenses.
2. Reimbursements cannot be made for expenses itemized as tips or gratuities.
3. Conference expense claims must reflect expenses of the individual only.
4. Record conference mileage on this form.
Submit original and two copies to your Department Administrator for approval. Retain a copy for
your records and staple all receipts to the claim form.
(Last)
(First)
(MI)
Date
Meals
Registration
Conference title:
$
Social security number / W #:
Date(s) Attended Conference:
Total Miles:
@
Other Expenses
¢ per mile
Location (City, State):
$
$
$
$
Daily Total
(Telephone, Taxi, Parking, Mass Transit, Etc.)
Miles
Traveled
Lodging
$
Total Claim:
$
Cost of Transportation:
Subtotal:
Less Advances:
Less P-Card:
$
$
-$
-$
Total Daily Expenses:
I certify that the above itemized claim represents actual and necessary expenses incurred by me while on authorized school business for
Public Transportation: From: _______________ To: _______________ Via: _______________ One-Way Two-Way
Expense Limit: $
APPROVED:
the purposes stated above.
Employee signature:
EXAMINED AND ALLOWED:
DISTRICT BUSINESS OFFICE:
DEPARTMENT ADMINISTRATOR:
CHARGED TO EXPENDITURE ACCOUNT NUMBER:
Date:
.545
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