Montana State University
Sponsored or Reimbursed Travel Disclosure Form
OSP June 2012
(To be completed by Investigators proposing or performing Public Health Service (including NIH) funded research)
Traveler’s Name
Position
Department
Destination
Dates of Travel
Purpose of Travel
Name of Sponsor
Describe the relationship of travel to institutional responsibilities:
Nature of sponsored or reimbursed travel expenses (e.g. transportation, hotels, meals, entertainment):
I hereby disclose the above-described travel provided to me free of charge.
Signature Date
Sponsored or Reimbursed Travel is travel paid for or reimbursed to the employee by a third party.
This term does not include travel paid for by MSU using sponsored research funds.