
To: VicePreside
n
tforAdministrationandFinance
From:
Date:
Subject: RequestforReimbursement
Reimbursement for meal expenses incurred as an official University host is requested.An original itemized
receipt(s)isattached.Theexpenseswereincurredin(nameoftown)

IndexCodeFundOrganizationAccountProgramCodeNu
mbers Amount

IndexCode‐F
undOrganizationAccountProgramCodeNumbers Amount
JustificationforMealExpense:
ListofParticipants(firstandlastname):

SignatureofRequestorSignatureofDepartmentHead
PrintedNameofRequestorPrintedNameofDepartmentHead
VendorNu
mb
erofRequestorSignatureofDean(Ifapplicable)

PrintedNameofDean
ApprovedforPayment:
SignatureofChancellorOzarkCampus
(requiredforallOzarkCampusemployees)
VicePresidentforAdministrationandFinance
Travel Services
203 West O Street
Russellville, AR 72801-2222
479-356-6209
travel@atu.edu
Revised January 2017