Fillable Split Mileage Reimb Worksheet SPLIT ASSIGNMENT MILEAGE REIMBURSEMENT WORKSHEET

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Split Mileage Reimb Worksheet SPLIT ASSIGNMENT MILEAGE REIMBURSEMENT WORKSHEET

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SPLIT ASSIGNMENT MILEAGE REIMBURSEMENT WORKSHEET
FOR USE BY REGULAR/PART TIME FACULTY
(Reference Article 4.17.2 of Agreement)
Name:________________________ Sections taught:___________________________
Primary location: SLO _____ NCC _____ AGHS _____ NHS _____
“Split Assignment” is a regular assignment to more than one designated
campus/center site on a scheduled workday of the affected faculty member.
Split assignment days and locations: Please attach a separate schedule.
Number of miles to outlying campus (one way): __________(A)
SLO to NCC = 36 miles
SLO to Arroyo Grande HS = 22 miles.
SLO to Nipomo HS = 32 miles.
NCC to Arroyo Grande HS = 46 miles.
NCC to Nipomo HS = 55 miles.
NCC to CMC = 34 miles.
Number of split assignment workdays: __________ (B)
Multiply A times B: __________ (C)
Standard IRS mileage rate for the period: __________ (D)
(Available from Fiscal Services)
Multiply C times D. This is your reimbursement amount: $____________
Attach this worksheet to a Conference Request/Travel Reimbursement Form. Obtain
required approvals. Submit the form and supporting documents to the Budget office.
For Office Use Only
Split Assignment (Y/N):______ Reimbursement rate: $________per mile.
Regular or Part Time Faculty: _______
Verification of workdays reported (Y/N):_____
Verified by: _________________________ Date: ____________
Office use: G:/FORMS/Split Reimb Worksheet
Revised (Fiscal Services): 5/17/19
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Split Mileage Reimb Worksheet SPLIT ASSIGNMENT MILEAGE REIMBURSEMENT WORKSHEET

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Completed 27 November 2019

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