25-26 DMESC Request for Reimbursement for PD/ Travel.xlsx

	A	B	C	E	H	K	M	N	O	Q	S	T	W	X	Z	AC	AF	AG	AI	AJ	AN	AP	AR	AS	AT	AV	AY	BH	BM	BP	BR	BS	BV
1										DMESC CTE Request For Individual Reimbursement
2										DMESC CTE Request For Individual Reimbursement
3										(ATTACH AGENDA AND DESCRIPTION OF TRAVEL)
4																				25-26
5																SCHOOL YEAR				25-26
6
7	NAME																					SSN#
8
9	MAILING ADDRESS																					SCHOOL DISTRICT
10
11	NAME OF ACTIVITY/IN-SERVICE																							LOCATION
12
13	Fund/Source of Funds				Funt	Loc		Subj		Prog	Account			1099 Y/N	Qty	Description (Including Invoice Number Paid)									Unit Price		Amount
14	6570				1395	000		000		00	65810					Lodging											$0.00
15	6570				1395	000		000		00	65810					Meals											$0.00
16	6570				1395	000		000		00	65810					Incidental (Registration)											$0.00	Perkins Project Number				Budget Category
17	6570				1395	000		000		00	65810					Incidental (Parking)											$0.00
18	6570				1395	000		000		00	65810					Travel											$0.00
19																								TOTAL			$0.00			(DMEC Purchase Order Number)
20
21	DATE			EXPENSES																						TRAVEL BY PRIVATELY OWNED VEHICLE
22	Mo.		Day	Name Of Town Visited			Common Carrier			Hotel Room		Meals	Per Diem		OVERNIGHT			Taxi		Incidentals (Codes below)	Baggage		TOTAL PER DAY			FROM	BETWEEN WHAT POINTS		TO	Mileage Driven		District Rate Per Mile	AMOUNT CLAIMED
23	Mo.		Day	Name Of Town Visited			Common Carrier			Hotel Room		Meals	Per Diem		Depart. Time	Home Arrival Time		Taxi		Incidentals (Codes below)	Baggage		TOTAL PER DAY			FROM	BETWEEN WHAT POINTS		TO	Mileage Driven		District Rate Per Mile	AMOUNT CLAIMED
24																							$0.00										$0.00
25																							$0.00										$0.00
26																							$0.00										$0.00
27																							$0.00										$0.00
28																							$0.00										$0.00
29																							$0.00										$0.00
30																							$0.00										$0.00
31																							$0.00										$0.00
32							0.00			0.00		0.00	0.00					0.00		0.00	0.00		$0.00							0			$0.00
33
34		INCIDENTALS:
35
36					(1) Postage				(2) Parking Fee				(3) Registration Fee				(4) Emergency Car Repairs
37					(5) Guide Service for the Blind								(6) Minor Purchases				(7) Meals for State Guests and Wards of State											TOTAL EXPENSES BELOW
38					(8) Other (Explain)																							TOTAL EXPENSES BELOW
39
40		Approved																										EST. EXPENSES SUB-TOTAL			$	$0.00
41					CTE Coordinator														Signature of Traveler
42																												MILEAGE CLAIM ESTIMATE			$	$0.00
43		Approved
44					BUILDING PRINCIPAL																							TOTAL ESTIMATED EXPENSES			$	$0.00
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