Travel Reimbursement Request

If you have questions regarding the University’s travel guidelines and policies please visit, http://controller.ofa.ncsu.edu/thetravelcenter/

"*" indicates required fields

1About You

2Travel Details

3Prepaid Expenses

4Reimbursement Expenses

5Certification

Name*

First Last

Email*

Student/Employee Number

NC State University students/employees only

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Project ID

The Project ID number to be charged—e.g.: 5xxxxxx, 6xxxxx, etc.

Destination*

To and From

Departure Date*

MM slash DD slash YYYY

Return Date*

MM slash DD slash YYYY

Purpose of Travel*

ex. Conference Name, Collaborating with Jane Appleseed at Carnegie Mellon University

Conference Details*

Conference Program web address. For agenda please be detailed (dates, times, people met with, etc.)

Prepaid Expenses

Did the ECE Department prepay for any of your expenses? If the Department prepaid for any of your expenses in the next section, you DO NOT need to fill in any information related to the prepaid expense.

Airfare

Hotel

Conference Fees

Rental Car

ONLY include expenses you are looking to be reimbursed for. Prepaid expenses by the Department DO NOT need to be listed in this section. All receipts must be itemized and in the Traveler’s name.

**Receipts not in US dollars must be converted by using the conversion website**

Flight Expense

Ex. Delta $165.89

Parking Expense

Ex. 12/9/16-12/12/16 – Airport – $60.00, 12/10/16 – conference – $10.00, 12/11/16 – Conference – $10.00

Transportation

(Please specify date, amount, traveling to and from for each receipt). Ex. 12/9/16 Taxi from home to RDU – $25.00, 12/9/16 taxi to hotel from airport – $18.00

Rental Car Company and Expense

Travel Milleage

Personal vehicle use ONLY

Route Documentation*

Please send, along with your other backup travel documentation, a scan of either Google Maps or MapQuest confirming that the travel miles listed above matches the distance from NC State to your destination and back.

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.

Hotel Name & Expense

Conference Name and Fees

Per Diem Meals

Use the space below to list ONLY EXCLUDED meals (these are meals you will NOT need reimbursement for). Ex: 6/29-7/3 exclude all lunches. For further information please visit the University Controller’s website, http://controller.ofa.ncsu.edu/thetravelcenter/before-the-trip/meals/

Additional Expenses

Please specify type of expense and amount. Ex. Baggage Fees, Internet, Gas (rental car), Paper Registration Fees etc.

Itemized Receipts

You may also drop off the receipts in person at 3114 Engineering Building II.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.

Certification*

I certify that the information I have provided is accurate.