Fillable eastern florida state college Student Travel & Reimbursement Form E

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eastern florida state college Student Travel & Reimbursement Form E

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File type: PDF

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Student Travel & Reimbursement Form E#
Signature
of
Sponsor
Date
Approved:
Supervisor
Date
Budget
Custodian/Campus
Provost
Date
Accounting/Budget
Date
Include Acknowledgement Form and Agenda with Travel Form
(PLEASE TYPE)
Sponsor’s Name: B#: Phone:
Index # Campus Department Building # Room #
Destination: (City and State)
Meeting/Conference
Departure Date
Time
AM
Return Date Time
AM
PM
Select Day: __S __M __T __W __R __ F __S
Select Day: __S __M __T __W __R __ F __S
Statement of Benefit: Indicate the purpose of the travel and the benefit to the college from the trip:
Prepay Airfare Prepay Registration Fee Prepay Game Meals Prepay Lodging College Vehicle
Student Costs/Index #
Student
Estimated Cost
Student
Ck/Pcard Pymts.
Student
Amount Claimed
Employee
Estimated Cost
Employee
Prepay
Payments
Employee
Amount Claimed
Reimbursement/
Amount Due EFSC
(Accounting Use)
Airfare
Rental Car, tax, limousine, bus
Registration Fee
Map Mileage ( ) x 44.5 per mile)
Vicinity Mileage ( ) x 44.5 per mile)
Tolls/Parking
(attach receipts if greater than $15)
Phone (itemize receipts)
Other (specify)
Students Meals (estimate) X Days x
Rate =
Lodging (Days x Rate=)
Total Costs
TO BE COMPLETED 5 DAYS AFTER RETURN TRIP
Attach acknowledgement for, registration receipt, hotel bill and all other receipts.
SPONSOR Meals Calculator
Breakfast $         Lunch $
Dinner $
Acknowledgement Form must be
completed for student meals.
Before 6:00 a.m. ($6) S M T W R F S Before 12:00 noon ($11) S M T W R F S After 8:00 p.m. ($19) S M T W R F S
I hereby certify or affirm that this travel claim is true and correct in every material matter; that the expenses were
actually
incurred by the
undersigned
as
necessary
travel
expenses in the
performance
of my official duties; and that same conforms in every respect with the requirements of Section 112.061, Florida Statutes.
Sponsor’s
Signature: Date:
Supervisor’s
Signature:
0.00
0.00
0.00
0.00
0.00
0.00
Student Acknowledgement/Receipt of Meals or Money
Sponsor’s Name B# Phone
Departure Date
Time
AM
PM
Return Date
Time AM
PM
TOTAL DAY/S:
Departure Day S
M
T W R
F S
Return Day S M
T
W R F S
Breakfast (must leave before 6 a.m.) $3 Lunch (must leave before 12 noon.) $6 Dinner (must return after 8 p.m.) $10
To my knowledge I hereby certify the information provided is accurate. (Please sign below under Student Signature.)
Name (please print)
B#
Meals Provided OR Dollar Amount Provided
Accounting
Student’s Signature
1
B
L
D
Amount Received $
2
B
L
D
Amount Received $
3
B
L
D
Amount Received $
4
B
L
D
Amount Received $
5
B
L
D
Amount Received $
6
B
L
D
Amount Received $
7
B
L
D
Amount Received $
8
B
L
D
Amount Received $
9
B
L
D
Amount Received $
10
B
L
D
Amount Received $
11
B
L
D
Amount Received $
12
B
L
D
Amount Received $
13
B
L
D
Amount Received $
14
B
L
D
Amount Received $
15
B
L
D
Amount Received $
TOTAL:
B
L
D
Received $
If you have any cause for concern that the above has not been accurately reported, please contact the Accounting Office at 433-7047.
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eastern florida state college Student Travel & Reimbursement Form E

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Completed 1 December 2019

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