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form also available in the following formats: xls,
.pdf
Person
Responsible: __________________________
TA Reference: _______________________________
| Date |
Individual/
Team/
Group
Lodging |
Individual/
Team/
Group
Breakfast |
Individual/
Team/
Group
Lunch |
Individual/
Team/
Group
Dinner |
Total
Actual
Costs
of Meals** |
Total
to be reimbursed |
| |
. |
. |
. |
. |
. |
. |
| . |
. |
. |
. |
. |
. |
. |
| . |
. |
. |
. |
. |
. |
. |
| . |
. |
. |
. |
. |
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| . |
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| . |
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| TOTALS |
. |
|
** |
. |
The
above costs represent the actual costs incurred in the performance
of University business.
__________________________________
Traveler's Signature
* Receipts
for lodging must be provided to support actual amounts claimed.
If meal costs exceed $28 per day, receipts supporting
the costs must be attached; otherwise, this schedule of meals
will suffice
** Enter this amount on the per diem line in
Section 4 of the Travel Authorization.
This
form also available in the following formats: xls,
pdf
Travel
policy related to this form
