HAMPSHIRE COLLEGE
TRAVEL REIMBURSEMENT FORM
Full Legal Name: _____________________________________________________ Phone: ________________________________
Please Print
Legal Address: _________________________________________________________________________________________________
Street City State Zip Country
Mailing Address: _______________________________________________________________________________________________
Street City State Zip Country
Please check one: Employee Student Vendor Alumni
Please record appropriate business expenses below. Provide a business purpose for all expenses. Attach the Mileage Worksheet if entering in the Ground column. Please
attach original itemized receipts for expenses $20 and above. If original itemized receipts are not available please complete a Missing Receipt Affidavit.
Description of trip and/or expense, plus attendees (if applicable) ______________________________________________________________________________
________________________________________________________________________________________________________________________
Total Reimbursement Allowed: ______________
I certify that these are all legitimate Hampshire College expenses for which I request reimbursement.
____________________________________________ _______________________________________ ________________________
Payee Signature Payee Name (Please Print) Date
I have reviewed these expenses and all are in accordance with College policy.
____________________________________________ _______________________________________ ________________________
Budget Manager Signature Budget Manager Name (Please Print) Date
***One Business Trip Per Form***
