W
FACULTY TRAVEL BENEFIT
REQUEST FORM
2019–2020
THIS FORM MUST BE SUBMITTED TO JESSICA MARTIN PRIOR TO TRIP DEPARTURE.
NAME: DATE:
DEPARTMENT:
E-MAIL: CAMPUS EXTENSION:
NAME OF MEETING:
LOCATION OF MEETING:
DATES OF ATTENDANCE:
PARTICIPATION:
WILL YOU BE MAKING A SCHOLARLY CONTRIBUTION TO THE CONFERENCE? YES: NO:
TITLE OF PAPER TO BE PRESENTED:
SESSION TO BE CHAIRED/DISCUSSED:
OTHER:
AIR TRAVEL (ROUND-TRIP AIRFARE BETWEEN LOCAL AIRPORTS –
CLEVELAND, AKRON/CANTON OR COLUMBUS - AND DESTINATION CITY):
QUOTED FARE: $ TRAVEL AGENCY:
OTHER ESTIMATED COSTS:
LODGING: $ MEALS: $ REGISTRATION: $
GROUND TRANSPORTATION/PARKING: $ LOCAL TRANSPORTATION: $
Internal Revenue Service regulations requires the presentation of original, detailed receipts
for lodging, meals, airline tickets and parking with your reimbursement request.
All items must be reported in U.S. currency.
Please notify the Chair of your department/program of your conference dates.
To request your Faculty Travel Benefit,
please submit this completed form to Jessica Martin in the office of the Provost prior to your trip.
5/25/18
