Fillable Name Period Covered District Program/Site No.of Date DepartureLocaon

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Name Period Covered District Program/Site No.of Date DepartureLocaon

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TRAVEL EXPENSE REIMBURSEMENT REQUEST
EES 01/22
MILEAGERATEEFFECTIVEFORJANUARY1,2022
Name
District
Period Covered
Program/Site
Date DepartureLocaon Desnaon ReturnLocaon
No.of
Miles
TRAVEL EXPENSE REIMBURSEMENT REQUEST
ES 01/2022
MILEAGERATEEFFECTIVEFORJANUARY1,2022
Date DepartureLocaon Desnaon ReturnLocaon
No.of
Miles
I hereby certify that all items of expense included in this statement
were incurred in the discharge of official business. Amounts are
correct and represent proper charges to the district.
Employee
PrintName
Signature Da
te
ApprovedBy
(Employee’sSupervisor/Director/Superintendent) Date
Chargesverifiedby:
DatesenttoGECS:
FORGECSUSEONLY
AccountNo.
CurrentCarInsuranceVerified‐INITIALS:______
Signature
FORDISTRICTUSEONLY
Account/P.O.#: $
$
Name Period Covered
District Program/Site
**ATTACHACOPYOFYOURCARINSURANCETOTHISFORM**
0
.585
$ 0.00
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Name Period Covered District ProgramSite No.of Date DepartureLocaon

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Completed 14 June 2022

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