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DOMESTIC TRAVEL REIMBURSEMENT WORKSHEET
 

Summary: DOMESTIC TRAVEL
REIMBURSEMENT WORKSHEET
Submit completed form along with all original receipts to your travel processor
Name: ____________________________________ Date: ______________________________________
UC-employees please enter your Employee ID#:_______________ Non-UC travelers -your SSN # is required:______________________
Address: ______________________________ U.S. Citizen: Yes No
______________________________ City of Residence: __________________________
Extension: ______________________________ Vendor ID (if known): __________________________
E-mail Address: ________________________ Home Campus: __________________________
Account to be charged: ___________________________________________________________________
Purpose of Travel: _________________________________________________________________________
Destination: _______________________________________________________________________________
Initial Departure Date: ________________________ Return Date: ________________________________
Initial Departure Time: ________________________ Return Time: ________________________________
Did you obtain a Travel Advance for this trip? No Yes $_______________________________
Was there any personal time during this trip? No Yes From: ____________ To:____________
TRANSPORTATION
Airfare: $___________ RT Paid for by: Credit Card Charged to Department
Private Car Mileage: _____ License Plate #: ___________ Check here to confirm your liability insurance
Rental Vehicle: $_____________ Rental Vehicle Gasoline: $___________ UC Vehicle: Yes No

  

Source: Ahlers, Guenter - Department of Physics, University of California at Santa Barbara

 

Collections: Physics