Request for Travel Approval » Department of Neurology » College of Medicine

Request for Travel Approval Form

Department of Neurology REIMBURSEMENT: To insure prompt processing of travel reimbursement, all pertinent data and receipts must be forwarded to the Fiscal Section within five (5) working days of the employee's return. Please be advised that it is to your advantage to retain ANY and ALL receipts, which reflect funds expended while on your trip.

Date*
Name*
First Last
Email
UF ID Number:
Type of Travel:*
Destination*
City/State or Country
Name of Conference:*
Purpose of Trip:*
- Annual Meeting
- Presentation
- Moderator
- Conference Attendee
- Other - explain in justification below
Justification*
Explain benefit to the State
Funding Source*
Name of Grant or Funding Agency:*
This field must be filled in if you checked Other or have a Grant or Funding Agency.
Outside Employment*
- Yes
- No
Organization Name
Please be sure you have a Disclosure of Outside Activities and Financial Interests form on file with the department. These forms can be found at http://www.med.ufl.edu/busforms.com or contact the department.
Registration Prepayment Needed:*
- Yes
- No
Prepayment Due Date:

Please allow 4-6 weeks.
Departure Date:*
Depature Time:*

: HH

MM
Return Date:*
Return Time:*

: HH

MM
Number of Days:*
Please enter a number from 1 to 30.
Departure Airport:*
Destination Airport:*
Estimated Costs
Cost of Airfare:
Hotel Cost Per Night?
Total Nights in Hotel:
Meals - Breakfast
Price: $6.00 Quantity:
Meals - Breakfast
GSA rate applies. Please enter the NUMBER of meals you have had in this category.
Meals - Lunch
Price: $11.00 Quantity:
Meals - Lunch
GSA rate applies. Please enter the NUMBER of meals you have had in this category.
Meals - Dinner
Price: $19.00 Quantity:
Meals - Dinner
GSA rate applies. Please enter the NUMBER of meals you have had in this category.
Registration Cost:
Rental Car Cost:
Mileage: (miles)
Price: $0.44 Quantity:
Miscellaneous Expenses:

Any unusual extra expense due to changes in reservations may have to be borne by the traveler. Always coordinate reservations/changes with your secretary or the fiscal office (352) 273-5550.
Total
$0.00
Approvals
Duties will be covered by:
Traveler's Signature:
Approved by:
Program Director/Chief
Approved by:
Polly Glatti
Approved by:
Department Chair/ Michael Okun, M.D.
Fiscal Section:
Funding Allocation/Robin Smith
Account Number

Request for Travel Approval Form

Estimated Costs

Approvals