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TRAVEL EXPENSE STATEMENT
PART I.
BUDGET CODE/FUND: DEPT:
NAME:
TRAVELING TO: DATE(S):
RECEIVED BY: "FINAL SETTLEMENT DATE"
(7 days after travel)
Amount of Advance:
Date Received:
PART ACTUAL EXPENSES INCURRED
TUITION AND REGISTRATION FEES* $
LODGING-(room and tax only)*
COMMERCIAL TRANSPORTATION COSTS-AIR, RAIL, ETC.*
TRANSPORTATION COSTS - TAXI, SHUTTLE, ETC.
MILEAGE - PERSONAL AUTOMOBILE: ___________________________ @____________.mile _______________
MEALS, TIPS & OTHER INCIDENTAL EXPENSES (Per Diem Rate)
PROMOTIONAL AND ENTERTAINMENT COST: *
(Attach a brief description of event)
OTHER-TOLLS, PARKING, LUGGAGE, ETC.:
TOTAL EXPENSES:
SUBTRACT: AMOUNT OF ADVANCE
PREPAIDS
BALANCE - check one
DUE NNRHA [ ] DUE EMPLOYEE [ ]
I hereby certify that the above amounts are true and correct.
_____________________________________________________ ______________________________________________________________
Traveler Date Department Director Date
______________________________________ ___________________________________________
Executive Director Date Director of Finance Date
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