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Request for Travel Reimbursement Name: E-mail address

Summary: Request for Travel Reimbursement

Name: E-mail address:
PTAO if known, or source of funds (ie research funds, department travel, etc.)

Are all receipts included? If not, why.

This form must be submitted within 30 days no matter what the source of funds. Is this form being
submitted within 30 days? If not, why.

Dates of Travel:
Times of Travel: Start Return
Name and Location of Conference:

Purpose of Trip (ie present paper, participate in round table, etc):
US Dollars Only!! (exchange rate: $___________________)
Registration Fee: $
Taxis or Metro (circle one): $ Airfare/Bus/Train (circle one): $
Personal Vehicle Expense: Mileage: or Rental Charge: $
Parking: $ Tolls: $


Source: Acton, Scott - Department of Electrical and Computer Engineering, University of Virginia


Collections: Computer Technologies and Information Sciences