College of Music & Dramatic Arts Travel Reimbursement Request Form
Minimum requirements are highlighted in Red.
AS292 - Request for Authorization to Travel, should be turned in prior to travel to claim reimbursement.
ALL RECEIPTS MUST BE ATTACHED AND SUBMITTED WITH THIS FORM, EXCEPT THOSE
REQUIRED FOR LACARTE CHARGES.
Receipts for LaCarte should be submitted with the LaCarte Entry Log when charges are due.
Traveler: Date Submitted:
Destination:
Departure Date: Return Date:
Time of Departure:
AM / PM
Time of Return:
AM / PM
EXPENSES PAID ON LACARTE OR CBA (Do not include reciepts)
Registration Airfare Luggage Fee Airport Parking Lodging Rental Car Miscellaneous
$ $ $ $ $ $ $
Entry # Entry # Entry # Entry # Entry # Entry # Entry #
Please list below all miscellaneous expenses:
EXPENSE RECEIPTS (List expenses NOT paid on LaCarte)
Registration Fees Airfare (not paid by CBA) Luggage Fee
Airport Parking
$ $ $ $
Mileage* Lodging Are Meal Per Diems being claimed? Rental Car Miscellaneous
$ $
Yes No
$ $
Were any meals paid for or provided by the hosting organization/conference/hotel?
Yes No
If yes, please list below which meals were paid or provided (ex. 1/1/13 lunch, 1/2/13 dinner, etc. )
Please list below all miscellaneous expenses:
Total Amount Requested for Reimbursement ----------------------------------------->
$
I am receiving additional funding outside from CMDA, (ex. travel grant, TAF, etc.)
Yes No
*Mileage Information (include documentation, i.e. mapquest route printout)
Was mileage in-state or out-of-state? In-State Out-of-State
If mileage was out-of-state, was an airfare quote obtained prior and attached? Yes No
I certify that all expenses claimed on this request were paid by me and incurred on University business.
I also certify that I have submitted all receipts and lled out this form complete as to the best of my knowledge.
Traveler: _________________________________________________ Date: ______________________
FOR OFFICE USE ONLY: Voucher Number:_______________ Date:_____________
