Travel Authorization and Travel Advance Request Checklist
In order to save time in completing this form and processing your travel request, the following “checklist” was
developed. If you have questions when completing your “Travel Authorization and Travel Advance Request Form,”
please call ext. 3717. Submit “Travel Authorization” for each trip, even when there are no funds requested.
Receipts and a copy of Travel Authorization and Tra
vel Advance Request must be attached. Books and individual
membership fees must be reimbursed by submitting a memorandum with receipts attached to your immediate
supervisor and appropriate vice president.
Date of Request: (date you complete the form)
Nature of Request: (check either in-state and/or out-of-state)
Traveler: (name of person traveling)
Dept., (the department in which you work), ex. “Business”
Source of Funds: (unit no., ex. 38800)
Destination: (city and state)
: (workshop, class, etc.)
Date of Meetings, etc.: (beginning date and ending date), ex. “02/13/2011 to 02/15/2011”
Title of Program: (name of class, workshop, etc.)
Date Leaving and Time: (date and time leaving, including a.m. or p.m.)
Date Returning and Time: (date and time returning, including a.m. or p.m.)
Other Employees Traveling: (list any other employee traveling with you)
Mode of Transportation: (check applicable box)
Estimated Expenses: Lodging, Meals, and Transportation costs are based on State rates.
Lodging: (list no. of days and enter amount per day, including taxes, and total amount
for lodging. If advance is requested, complete last column, “Advance.” In-state Lodging:
$75.10 per day; Out-of-State Lodging: $88.70 per day)
Meals: (list no. of days and enter amount per day, and total amount of meals. If advance is
requested, complete last column, “Advance.” In-State Meals: Breakfast: $8.60; Lunch, $11.30;
Dinner, $19.50; Lodging, $75.10. Out-of-State: Breakfast: $8.60; Lunch, $11.30; Dinner,
$22.20; Lodging, $88.70.
Transportation: When round trip does not exceed 100 miles (regardless of number of days
traveled) employees can be reimbursed for mileage at 58 cents.
When round trip does exceed 100 miles (regardless of number of days traveled) employees can
be reimbursed for mileage at .33 cents.
This rate is set by the IRS.
Other Expenses: (If you do not want the registration fees, airline tickets, etc. to be paid in
advance, enter those estimated expenses in this area.)
Signatures – faculty: (traveler; department chair; Rebecca Roush) (all sign and date)
Signatures – staff: (traveler; supervisor, appropriate vice president) (all sign and date)