Conference Request/ Travel Reimbursement Form

Name: Dept:

Conference Request Information Conference Name: Dates: From Through (inclusive) Reason for Attending / Explanation of Actual Expenses Cost Estimate Transportation: Mileage: Meals: Lodging: Fees:

Pre-approval and Authorization Division Chair/Director's Signature: ________________ Administrator's Signature: _______________________ Vice-President's Signature: ______________________ Amount Approved: President/Superintendent's Signature:____________________

Advance Request Payable to: Amount Date Needed: Mileage Calculation Mileage: = $ Total Description:

Actual Expenses Transportation: Mileage: Meals: Lodging: Fees: Misc. Expenses: Less Advances and/or Am Ex:

Account # ---
Account # ---
Requestor's Signature:___________________________________________
Administrator's Final Review and Approval:__________________________ Date:_________