ABCDEFGHIJKLMNOPQRSTUVWXYZAA
1
Ririe Joint School District #252
Travel Request and Expense Reimbursement Form
2
Please use the school credit card and a purchase order when possible.
3
*Please submit separate forms for different trainings.Totals
4
Name:
5
Purpose of event:
6
Location of event:
7
Time leaving home, include date and time:
8
Time returning home, include date and time:
9
Total requested dollar amount for meals:
10
(Full day per diem is $55. Leaving home before 7:00 am and arriving home after 6:00 pm qualifies you for the $55. For partial days, the meal allowance is $13.75 for breakfast, $19.25 for lunch and $30.25 for dinner.) Receipts don't need to be turned in for meals, per diem will be issued if the event you are attending doesn't provide the meal and the meals are not provided by the hotels. The district may request a copy of your agenda stating that the meals will not be provided.
11
For gas or mileage reimbursement, please select only one of the three options below:
12
Miles/Days
13
Option 1: Total dollar amount for gas that I put in a school vehicle or Enterprise rental. (receipt required)
14
Option 2(if less than 100 miles): Number of reimbursable miles at .655 a mile.$0.45$0.00
15
Option 3: Reimbursement of personal car use (if chose not to use an enterprise rental). Will be reimbursed at the current rental car rate.$0.00$0.00
16
Lodging dollar amount (receipt required)$0.00$0.00
17
Parking dollar amount (receipt required)$0.00$0.00
18
Airfare dollar amount (receipt required)$0.00
19
Other expenditures, please describe below and include dollar amount:
20
Conference Fee$0.00$0.00
21
$0.00$0.00
22
$0.00$0.00
23
$0.00$0.00
24
Total$0.00
25
Disrict/ High SchoolAccount Number(s) you are paying for the request from
26
Signature and DATE of employee seeking reimbursement
27
Signature and DATE of building principal
28
Signature of the Business Manager
29
Before the reimbursement will be processed, receipts must be submitted and all signatures must be obtained. Thanks for submitting the receipts and this form together.
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100