***USE ONLY FOR IN‐STATETRAVELINEXCESSOF2WEEKS***
Comptroller's Office
Phone Number (10 digits):
Depart Return Description Amount
Advance
Registration
Other
(listinnotes
below)
Vice President's Printed Name (if required) Date
Supervisor's Printed Name
Date
Traveler'sSignature Date
TOTALTRAVELEXPENSES
LESSADVANCERECEIVEDAND/OREXPENSESPREPAIDBYUNIVERSITY THAT ARE CLAIMED ABOVE
PublicTransportation
(Air,Bus,Train,etc.)
PerDiem
OtherExpense
DailyExpense
From
To
Date
mm/dd/yyyy
Time
(DayTripsOnly)
Location(City)
Mileage
Rate
(updated
annually)
Mileage
ReimbAmt
Email Address:
INSTRUCTIONS:
Fillouteachapplicablesection.Handwritten,incomplete,orunsigned/datedformswillbereturned.
TravelSummary(mustincludepurpose,
location(s),anddaterange)
TRAVEL EXPENSE REPORT (IN-STATE LONG FORM)
Name of Traveler: Encumbrance & FOAP:
Traveler Vendor A-Number: School/Div & Dept:
COFORM‐REVISED 01/22/20
Other Approver's Printed Name (if required) Date
Vice President's Signature (if required) Date
Other Approver's Signature (if required) Date
Supervisor's Signature Date
A
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$ 0.575
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$ 0.575
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$ 0.575
0.00
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$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
$ 0.575
0.00
0.00
0
$ 0.575
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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