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N C State University - Non-Employee Travel Authorization Form (AP104) (This form has embedded drop down boxes. If you click on a box and you see an arrow that means it has a drop down list to select from. Otherwise you will need to key in the requested information.)
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Traveler's Name (Last/First/Middle)Traveler's Vendor NumberName/Number of Contact Person
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Travel To (Destination)Travel Begin DateTravel End Date
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Explain what the travel is for (Please be specific and do not use acronyms):
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Select the service / benefit provided to the University by this trip:[ Click on this box and select from the drop down list ]
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Is the non-employee traveler a student?
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Is this travel for In-State, Out-of-State or Out-of-Country?In State
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Is traveler a non-resident alien?If a non-resident alien, indicate visa type.
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If a non-resident alien, please mark "yes" in the box above. If not, continue to the Travel Commitment section.
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Controller's Office Tax SpecialistOK
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Travel Commitment (by Expense Type)Specific Authorizations (Select Yes or No)
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Air FareOver-Night Travel (including lodging and meals)
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MileageExcess Lodging Rates
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Vehicle RentalExcess Meals For International Trips
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ParkingBusiness Class Airfare For International Trips
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Other Ground TransportationVehicle Rental
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Conference / RegistrationsUse of Private Vehicle
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LodgingAttendants for Handicapped Employees
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MealsOther Departmental Items (explain):
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Other Travel Expenses
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Total Projected Expenses0.00
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FOR OUT OF UNITED STATES TRAVEL ONLY
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If travel is for out of the United States, Please answer the following questions. Questions 1 & 2 must be answered "yes" and question 3 either "yes" or "na". If you need to consult someone regarding these questions contact the Compliance Officer at SPARCS! If travel is within the United States only, this section is not applicable, go to the traveler's certification.
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List of CountriesPlease note the country you are traveling to in the box to the right:
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1 - Have you reviewed the SPARCS web site regarding federal laws regarding export controls and acknowledge your personal responsibility to comply with those laws and the personal consequences of failure to comply? (See links below)
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2 - Have you reviewed the US Secretary of State's web site and the Center for Disease Control (CDC) web site for Travel Warnings regarding Health and Safety factors? (See links below)
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3- If you plan to handle animals or visit farm or animal facilities, have you contacted the Institutional Animal Care and Use Committee (IACUC) web site regarding such activities and acknowledge your personal responsibility to comply with the guidelines, policies and procedures as outlined on that web site and the personal consequences of failure to comply? (See links below)
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SPARCSUS Secretary of StateCDCHomeland SecurityIACUC
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Compliance Officer for Integrity, Objectivity and Security in SPARCS
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Signature by the traveler indicates that he/she certifies that the information provided in this request is true and accurate and acknowledges that reimbursement is subject to university travel policy and for the documented service/benefit to the University.
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Traveler Certification (Signature/Date):
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For Department Use Only
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If for a student, are state appropriated funds being commited for this travel authorization?
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State funds are not committed - Please skip the next box and go the the Departmental Comments and Approval Line
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[ Click to select the reason for committing State funds from this drop down box: ]
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Department Comments:
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Department Head Approval (Name/ Signature /Date): (When travel is for a student and State funds are committed, the Department Head must approve directly and may not delegate authorization responsiblity.)
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Accounting Information: (Project(s) and Percentage must be completed)Trip #
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Project(s) to be charged:
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Percentage100.00%
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Amount0.000.000.000.00
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