STATEWIDE PARENT ADVOCACY NETWORK

REQUEST FOR REIMBURSEMENT

OF TRAVEL EXPENSES

 

PERSON(S) TRAVELING:           

 

DATE(S) OF TRAVEL:      

 

PURPOSE OF TRAVEL:  

 

TRAVEL FROM:

                                                                                   

TRAVEL TO:           

                                   

GRANT(S) TO BE CHARGED:   

OSERS:

%

 

 

PIRC:     

%

 

 

SCHS:

%

 

 

 

%

 

 

 

%

 

 

EXPENSES

$ Amount

 

 

AIR/TRAIN TRAVEL:

$

 

 

MILEAGE:

$

# of miles:

 

TOLLS:

$

 

 

HOTEL:

$

 

 

TRANSFERS:

$

 

 

MEALS:

$

 

 

OTHER (specify)

 

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

 

 

 

TOTAL:

$

 

 

INSTRUCTIONS:

1.      Attach receipts for expenses.

2.      List all grants that are to be charged for all expenses.

3.      *Note the % of expenditures to be charged to each grant.

 

Approved by:  _____________________________________

                                    Project Director/Coordinator

______________________________________________________________________________FOR FISCAL USE ONLY:                       

Date reimbursed ____________________________              Check # ________________ 

 

Executive Director/Associate Director ____________________________________________