Gsa Travel Award Application Packet Page 7
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7TRAVEL AUTHORIZATION / REIMBURSEMENT REQUEST FORM
I. TRAVELER DATA:
Name
Department
Home Address
Telephone Extension
II. TRIP DATA:
Dates
Location/Destination
Purpose of Travel
EXPENSE DATA:
IV. REIMBURSEMENT AMOUNTS
III. Travel Authorization
Estimate
Expense Type/Date
Total
$
$
Conference/Fees
$
$
Air/Train
$
$
Rental Vehicle
$
$
Hotel (Lodging only)
$
$
Meals*
$
$
Detail Sheet**
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Grand Totals
Proposed Accounts:
* Attach receipts if daily total exceeds $60
Prior Payments
** Attach detail sheet for mileage. Include receipts if total for taxis, parking and tolls
Account Distributions
exceed $25
$
$
Account:
$
$
Account:
$
$
Account:
$
$
Reimbursement Authorization
Account:
I certify that the expenses listed above were actually incurred and were
necessary to fulfill the mission of the university.
Travel Authorization
Traveler
Date
Traveler
Date
Chair (All Travel)
Date
Dean ($1,501-$3,500)
Date
Supervisor
Date
Provost/VP ($3,501-$10,000)
Date
President ($10,001+)
Date
Budget Controller (All Travel)
Date
Disposition of Check:
Mail to Above
Hold for Pickup
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