SignatureofTraveler___________________________________________Date_____________________________

I certify that the amounts given heron represent actual business related travel expenses and are in accordance with the current University of Chicago travel policy and procedures. If a copy of a receipt has been provided instead of an original, further certify that a I have not and will not be reimbursed for these expenses from any other source.

Date Item $ Amount

Airfare/Train

Taxi/Bus

Car Rental (Insurance is non-reimbursable)

Car - Personal (Mileage)

Parking

TOTAL $

TRAVELREIMBURSEMENTFORMCIRCAMPUSDAY

MailingAddress:

City:State:ZiporForeignCountry

TravelDate(s):- DesHnaHon:

BusinessPurpose:

C.EXPENSEDETAILSPleaseNote:TravelReimbursementisupto$200.00

List total reimbursement amount here: $______________________________________________________________

B. TRAVELINFORMATION

PayeeName:

Phone()- EmailAddress:

A.PAYEEINFORMATION

UNIVERSITYRECEIPTREQUIREMENTS

Travel reimbursements are defined as payments to individuals for reimbursement of expensesincurred while traveling on University related business. University travel is defined as businessconductedgreaterthan50milesfromtheUniversity’scampus.Travelforallnon-employeesshouldbereportedthroughtheePaymentsystem.

Expense ReceiptRequirements

TransportaHon• Airfare• Train• Taxi• Bus

Originalpassengerpaidreceiptifexpenseis$75ormore.Whenpurchasingairlinee-Dckets(electronicDcket),traveler’sshouldrequestapassengeriDneraryandpaidreceiptatcheckin.

CarRental Paidreceiptifexpenseis$75ormore.Note:DONOTpurchasecollisiondamagewaiver(CDW)orliabilityinsurancecoverageintheUSorCanada,butDOpurchaseinsurancecoverageinaforeigncountry.

Car-Personal(Mileage) Themileagereimbursementratefortravelon/aSerJanuary1,2019is58centspermile.MustpresentdocumentaDonshowingdates,numberofmilestraveled,starDngpointanddesDnaDon(ie,googlemapsormapquestprint-out).

Parking Paidreceiptifexpenseis$75ormore.

Please return your form and receipt to Tekeisha Yelton-Hunter at 5736 S. Woodlawn Room 204.