ACPA Travel Stipend Receipt Submission Form Name: Address

ACPA Travel Stipend
Receipt Submission Form
Name:
(first)
(last)
(MI)
Address:
(street address)
(city)
(apt. #)
(state)
(zip code)
College or University Affiliation:
Rank (please check one):
Student
Adjunct Prof
Assistant Prof
Associate Prof
Professor
Emeritus
Other
please explain
which of the following did you do at the meeting?
Present a paper
Comment upon a paper
Title of presentation at meeting (or the title of the paper you are commenting upon):
travel expenses:
Travel to and from conference:
Hotel:
Food:
Other:
Total:
Statement: "I certify that all the submitted expenses are for my own travels and that I
will not be reimbursed by any other person or organization for these expenses."
Signature
Please attach all receipts and send to the following address:
ACPA National Office
Center for Thom istic Studies
University of St. Thom as
3800 Montrose Blvd.
Houston, TX 77006
Date: