Request for Travel Reimbursement
TA Number:
If applicable
DA-130 (Authorization for Electronic Deposit) Completed?? Yes No
Report Name: Traveler Name:
Last First
Dates of Travel: / / to / /
MM DD YY MM DD YY
Destination:
Purpose of Trip: Conference Consulting Recruiting - Faculty/Staff Meeting Training
Team Travel Site Visit Vicinity Travel Recruiting - Student
Other
Report Type: Travel Report Date: System generated
Description of Trip:
Per Diem: Yes No
Meals provided by an external source (if a
conference, please provide a conference
agenda showing provided meals)
Date
Breakfast
Lunch
Dinner
Suggested list of attachments: Please provide to travel delegate in PDF format, if possible
Airfare (invoice from Sunflower Travel showing non-refundable ticket fee)
Airfare quotes (if flights not booked through Sunflower Travel)
Conference Registration Receipt (if applicable)
Lodging Receipt (showing zero balance)
Conference document showing conference hotel
Baggage Fee Receipts
Taxi/Bus/Shuttle Receipts
Parking Receipts (if available)
Toll Receipts (if available)
Rental Car receipts
Conference document showing provided meals (if applicable)
Currency conversion (if applicable) (www.oanda.com)
Exception against state policy (VP approval required)
Bank or credit card statement showing charges (when receipt not available)
Reset Form
15
15
Travel Summary
Mileage
Lodging
Other Expenses
Date
Departure
Time
Arrival
Time
Miles
Destination
Name
Amount
Description
Amount
Receipt/
Documentation

Additional comments: