Montana State University All Campuses and Agencies Fac/Staff
Travel Authorization and/or Travel Advance Request Student
* If you receive or apply for any US Public Health Service Funding (Including NIH), ALL travel sponsored or paid for by
a third party must be reported. See http://www.montana.edu/wwwvr/osp/OSP%20Travel%20Disclosure%20Form.pdf Rev June 2012
Traveler’s Name Campus/Agency GID#
Address (If Not Dept)
Department Contact Name/No
Banner Index/Acct -OR- Paid by (See Footnote*)
Destination and
Purpose of Travel
Depart Date/Time
Return Date/Time
Leave is approved; classes are covered. Yes No
I am combining this trip with a personal trip. Yes No
Travel is for a business purpose and is within my budget. If for a
grant/research project, travel is in accordance with the terms and
conditions of the award.
Yes No
Mode of Travel: Airline Private Car State Car Rental Car Other___________
Foreign 1. Subject to Fly America Restriction? Yes No
Travel http://www.tvlon.com/resources/FlyAct.html
Only 2. Completed Safety & Risk Form? Yes No
Foreign Travel Insurance Form
3. Leading Students on a Trip? Yes No
Leading Students Abroad Form
TOTAL TRAVEL ADVANCE REQUEST (optional)
ESTIMATED EXPENSES ALLOWABLE ONLY FOR ITEMS NOT ON P-CARD
Transportation:
$
Transportation:
$
Meals:
Meals:
Lodging:
Lodging:
Registration:
Miscellaneous:
Other:
Total:
$
Total:
$
By my signature I, the traveler/advisor, understand this is an advance and shall be used only for travel purposes. A
Travel Expense Voucher will be filed within ten (10) days after returning and will follow all rules and regulations set
forth by the State of Montana. Failure to file a Travel Expense Voucher with all supporting documentation will cause
a financial obligation to me. Reimbursements may be refused after 90 days.
Signatures and Approval
Employee Date:
Supervisor/Advisor Date:
Other Approver(s) Date:
If you are the final approver, please sign below to authorize travel and/or release payment:
Final Approval Date:
Request for Actual Cost
Lodging (if above state rate)
In-State (check one)
The city is listed on the high cost listing
provided by the Department of
Transportation
Lodging costs have temporarily
escalated due to special function
(list function) ________________
Emergency travel arrangement
precluded being able to find
accommodations at state rate
(list emergency) ______________
Remote Locations with limited
accommodation within a 15
-mile radius
preclude obtaining accommodations at
state rate
Out-of-State (all must apply)
Government rates were requested and
were not available at the hotel where the
employee is staying
Government rates are not available at
another hotel within a reasonable distance
from the convention hotel
Reimbursement at actual cost is within
the appropriation level authorized by the
agency
-OR- (either in or out of state)
For personal safety reasons, higher-
cost lodging is necessary for this location
0.00
0.00
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