Reimbursement Request for

 Non-Employee Travel Costs

        For UW services to process reimbursement requests, please provide the following info:

        Name: ______________________________

        U.S. Resident            _____         

        Foreign National     _____ (attach copy of I-94 form, visa, and passport with photo.  If J1 visa, provide copy of

                                     DS2019 form.  If F1 visa, provide copy of I-20 form.  If from Canada, provide copies

                                     of two forms of photo identification.)

        Last 4 digits of social security number:  ______________

        

        Mailing address  ___________________________

                                ___________________________

                                ___________________________

        Dates of trip:   __________ to ___________

        From city:         __________ to ___________

        Purpose of trip:    _______________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

                                            

        

        Claims:        Roundtrip Mileage ______ (reimbursed at 51 cents/mile)

                        Airfare Amt          __________ (limited to coach/economy class—paid receipt required)

                        Meals (itemize by day—limited to $34/day; $8 breakfast, $9 lunch, $17 dinner.  No receipts are required.  

No alcohol can be reimbursed by the UW—subtract alcohol costs from claim)

                         Date_______ B ___ L ___ D____

                                                Date_______ B ___ L ___ D____

                                                Date_______ B ___ L ___ D ____

                                                Date _______B ___ L ___ D ____

                        

                        List other claims and amounts below (i.e. parking, cabs, bus, other incidentals)

                        __________________        ________

                        __________________        ________

                        __________________        ________

                        __________________        ________

                

        

        --Visitors provide all original receipts to department staff or host--

        

        Attach any receipts and documentation, then route to ________________________