ENGLISH DEPARTMENT TRAVEL REIMBURSEMENT FORM

ENGLISH DEPARTMENT TRAVEL REIMBURSEMENT FORM
Following your trip, please return this completed form to the English Business Office (TWS 2119) along with
original, itemized receipts for all reimbursable expenses. Receipts must show or be accompanied by proof/method
of payment (ex—last 4 digits of a card number, or a bank statement).
TRAVELER AND TRIP INFORMATION
1. Traveler name:
2. Was a Travel Processing Form submitted for this trip? Please circle:
Y
N
or
If N, please submit a Travel Processing Form now. Please note this may delay your reimbursement.
3. Is the traveler currently on UMD payroll/enrolled as a UMD student? Please circle:
Y
or
N
If N, what is the traveler’s permanent address?
.
4. Destination:
5. Dates of trip: ____________ to ___________
EXPENSE INFORMATION
Note: please indicate if using currency other than USD
5. Air/Rail: $_________________ 6. Hotel/Lodging: $__________ 7. Conference fee: $____________
8. Ground transport—taxi, parking, local rail, etc.: a) $________ b) $__________ c) $___________
9. Per diem: please mark meals for which you would like to be reimbursed at the rate shown. No receipts required.
Date:
Breakfast ($9)
Lunch ($11)
Dinner ($25)
DAILY TOTAL
Note: To be reimbursed for breakfast on your first day of travel, you must depart on your trip before 6:30 am. For
dinner on your last day, you must return home after 6:30 pm. Please exclude any meals provided by conference.
10. Personal Vehicle Mileage: reimbursement is for $0.0575/mile, calculated by the business office based on driving
mileage from origin to destination according to Google Maps’ shortest route.
a) From ________________ to ______________ b) From ________________ to ______________
OR c) Rental car: $_____________
11. Other expenses (photocopy, phone, fax, etc.):
a) $________ b) $__________ c) $___________