Travel Voucher Worksheet printable pdf download

** For NCEAS Employees **

Travel Voucher Worksheet for NCEAS Residents

National Center for Ecological Analysis and Synthesis

Name ______________________________________________________________________________________________

Purpose and Destination of your trip: To represent NCEAS at _________________________________________

_____________________________________________________________________________________________________

E-mail Address _________________________________@nceas.ucsb.edu

Home Institution UCSB/NCEAS

Mailing Address (If other than NCEAS.) ________________________________________________________________

_____________________________________________________________________________________________________

Funding Source ____________________________________________________________________________________

 Yes

 No

Did you receive a Travel Advance for this trip? If so, specify amount: $ ______________________

Please tell us how you would like your reimbursement paid:

 Check

 Corporate Card

 Deposit to bank account used for Surepay payroll deposits

Travel Dates

Departure from your home Date

__________ / ___________ / __________

Time __________________

(MM/DD/YY)

Return to your home

Date

__________ / ___________ / __________

Time __________________

(MM/DD/YY)

Personal time (if any)

Dates

____________________________________________________________

(MM/DD/YY)

If you did not travel directly to/from the destination listed above, please explain and attach supporting documents.

_________________________________________________________________________________________________

Transportation (Must be accompanied by original receipts.)

Air (Attach original itinerary or passenger receipt showing proof of payment.)

$ _________________

Private car: License plate number _____________________

Mileage ___________________

 Yes

 No

Does your car have Liability Insurance?

Taxi/shuttle ____________________________________________________________________

Parking _______________________________________________________________________

Bus/train ________________________________ Other ________________________________ $ _________________

Lodging and Other Expenses

 Yes

 No

Did NCEAS pay the hotel directly for your stay?

If no, at which hotel did you stay? (Provide an itemized bill.) __________________________ $ _________________

 Registration Fees (Attach original receipts.)

$ _________________

Meals and Incidentals

Complete the Meal Reimbursement Worksheet (attached).

$ _________________

Estimated Reimbursement (excludes mileage and other reimbursement)

$ ___________________

Additional Reimbursement

If you will receive reimbursement from any other sources, please list the organization, what they are reimbursing,

and how much? ___________________________________________________________________________________

I certify that the expenses claimed above were incurred by me on official University business on the dates indicated.

Signature: __________________________________________________________

Date: ________________________

Please submit this completed worksheet to the front office within 5 days of your return.

Travel Voucher Worksheet

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