Arkansas Tech University
Russellville, Arkansas
To: President of the University
From: ___________________________
Date: ___________________________
Subject: Request for Reimbursement
Reimbursement for miscellaneous expenses incurred as official University host for
functions as follows:
Date
Town where expenses
incurred
Number of
Persons
Description of Function
Amount
Total:
______________________________ ______________________________
Signature of Requestor Department Head
______________________________ ______________________________
Printed Name of Requestor Dean Signature
______________________________ ______________________________
Vendor Number of Requestor Vice-President Signature
______________________________
Chancellor, ATU - Ozark (if applicable)
______________________________
University President
Index Fund Org Acct Prog Amount
A copy of an approving Board Resolution dated October 27, 1994 is available upon
request.