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Fac Travel (Wichita State University)

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Faculty Travel Reimbursement Form
Please complete after returning from your trip and submit to Anne Marie Brown.
Name _____________________________________________
Trip Location ______________________________________
Departure Return
Date ________________ Date ________________
Time _________ a.m. p.m. Time _________ a.m. p.m.
If there were multiple legs on itinerary, please specify all departure and arrival details:
Were per diem (meal) expenses approved for this trip? Yes No
If yes, were any meals provided during your trip (ie: complimentary breakfast at hotel, meals provided during
conference)? Please explain:
Reimbursement Totals
Airfare: __________
• submit invoice and itinerary
Registration: __________
• submit conference agenda/schedule
Lodging: __________
• submit receipt
Car: Personal-Mileage __________
• submit Mapquest/Google maps showing mileage
Car: Rental __________
• submit receipt
Other expenses: __________
ie: parking, taxi, tolls, fuel
• submit receipts
Total Reimbursement: __________
Other notes or questions:
$ 0.00
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Fac Travel (Wichita State University)

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Completed 22 July 2020

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