MONMOUTH COLLEGE TRAVEL EXPENSE RECORD
(Revised April 2009)
To be completed and submitted to the Department Head (staff) or VPAA (faculty) AFTER the trip is completed.
Name ____________________________________ Department / Office _____________________________
Departure ________________________________ Return ________________________________________
Date Time (a.m./p.m.) Date Time (a.m./p.m.)
Trip Purpose & Destination ______________________________________________________________________
Pe
rsons Accompanying _________________________________________________________________________
»
»»
»TRANSPORTATION
TRANSPORTATIONTRANSPORTATION
TRANSPORTATION
If personal auto was used, did you request a college auto and it was not available? Yes______ No______
Odometer Reading (if used a college auto, attach the yellow copy of the Physical Plant Vehicle Authorization form)
Departure______________ Return______________ Total Miles______________________
Mileage Reimbursement Requested Car or minivan - $.36 per mile $ ________________
Full Van - $.42 per mile $ ________________
If College Car Available - $.20 per mile $ ________________
Air or Train or Car Rental From To___________________ $ ________________
TOTAL TRANSPORTATION
TOTAL TRANSPORTATIONTOTAL TRANSPORTATION
TOTAL TRANSPORTATION $ ________________
»
»»
»OTHER E
OTHER EOTHER E
OTHER EXPENSES
XPENSESXPENSES
XPENSES (Receipts and/or documentation are required with this report)
Dates:
Total
Breakfast - inc. tip* $ $ $ $ $ $ $ $
Lunch - inc. tip*
Dinner - inc. tip*
Tips - Porter & Misc.
Hotel (receipt required)
Taxi - inc. tip
Local bus or carfare
Misc.: Itemize
Total Other Expenses
Total Other ExpensesTotal Other Expenses
Total Other Expenses
$ $ $ $ $ $ $ $
TOTAL
TOTAL TOTAL
TOTAL TRANSPORTATION
TRANSPORTATIONTRANSPORTATION
TRANSPORTATION
AND
AND AND
AND OTHER EXPENSES
OTHER EXPENSESOTHER EXPENSES
OTHER EXPENSES
(from above)
(from above)(from above)
(from above) $_________________
- ANY ADVANCE RECEIVED $_________________
= REIMBURSEMENT REQUESTED OR AMOUNT TO BE REFUNDED
REIMBURSEMENT REQUESTED OR AMOUNT TO BE REFUNDEDREIMBURSEMENT REQUESTED OR AMOUNT TO BE REFUNDED
REIMBURSEMENT REQUESTED OR AMOUNT TO BE REFUNDED
TO BUSINESS OFFICE (use parentheses if refunding the Business Office)
TO BUSINESS OFFICE (use parentheses if refunding the Business Office)TO BUSINESS OFFICE (use parentheses if refunding the Business Office)
TO BUSINESS OFFICE (use parentheses if refunding the Business Office) $_________________
I hereby certify that these expenses were incurred by me as a necessary expense in the service of Monmouth
College, and have not been paid by any other source.
Signature ______________________________________________ Date _______________________________
Approved by Depart. Head (staff)____________________________Date________________Acct#_____________
Approved by VPAA(faculty)________________________________Date _______________Acct#_____________
Approved by Business Office________________________________Date _______________
