HTML Preview Sample Travel Expense Reimbursement Claim Form page number 1.


INSTRUCTIONS FOR TRAVEL EXPENSE REIMBURSEMENT FORM:
Each traveler will submit an itemized spreadsheet of expenses, along with original receipts, to Engineering Advising (103 Shaffer Hall).
The forms must be submitted in hard copy with original receipts AND electronically to [email protected], [email protected], or [email protected].
Below is a sample form to help you fill out your Expense Reimbursement Form (on page 3).
Each expense must be itemized and categorized, and a description must be provided.
Contact Denise Shipley, [email protected], Linda Moulton, [email protected], or Asst. Dean Janet Weise, [email protected], at with any questions.
STUDENT GROUP:
NAME OF TRAVELER:
AFFILIATION: (undergrad, grad student, faculty, staff, professional partner)
TRAVELER'S JHU PERSONNE see below
PROJECT/ACT (conference, South Africa implementation trip, Ecuador assessment trip, etc.)
TRIP DATES:
NAME OF TRIP LEADER:
Signature of traveler: verifying that all expenses are accurate
Signature of trip leader: verifying that all expenses are acceptable for reimbursement
Signature of treasurer: verifying that all expenses are acceptable for reimbursement
DATE LOCATION
CATEGOR
Y
DESCRIPTION PAYMENT FOREIGN CURRENCY US DOLLARS RECEIPT?
listed in chronological examples: examples: cash or List the expense in this List the expense number your receipts
order of purchase transportation airplane tickets credit card column if you paid in a in this column if and submit them in order
taxi foreign currency. Be you actually paid or write "no" if no receipt
train sure to specificy the in US dollars.
tolls type of currency. (i.e. You MUST provide a receipt
parking South African Rand) Transactions for all expenses 75 USD and
car rental should only greater.
gas for rental car appear in one of
gas for personal car these currency
driver fees columns.
exit fees
food breakfast
lunch
dinner
snack
lodging hotels (need itemized receipt if possible) - include name of hotel & number of nights in description
hostels
supplies project supplies
miscellaneous phone calls
passport fees
anything else
TOTAL: $0.00 $0.00
Revised 7/26/10 Page 1 Travel Expense Reimbursement Form.xls
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The man who will use his skill and constructive imagination to see how much he can give for a dollar, instead of how little he can give for a dollar, is bound to succeed. | Henry Ford