CCSU Foundation, Inc. Reimbursement of Expense Report
Rev. 3/2012
LODGING, MEALS & ENTERTAINMENT
Total Lodging, Meals & Entertainment:
TRAVEL
Total Travel:
OTHER EXPENSES
Total Other Expenses:
Report Total:
Date
Print Name Signature
I certify that the above expenditures have been incurred for approved Foundation purposes, are properly due, and have not been
reimbursed from other sources.
Description of expense
Relationship to Foundation activityDate(s) Total
Parking &
Tolls
TotalDate(s) Relationship to Foundation activity
From To
# of miles
Amount @
$
per mile
This form must be submitted by any individual claiming reimbursement from the CCSU Foundation and submitted along with a
completed Disbursement Order. Receipts or other supporting documentation must be attached.
List names of person(s) involved
Relationship to Foundation activity Meals Lodging TotalDate(s)
RESET FORM
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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