Travel Request Form

Complete this for including signature & date – attach supporting documentation (conference description, etc.) Submit for approval to Department Chairperson or Director; Approver forward to Dean of the College

TRAVELER INFO

Name (print):	Phone:

Status:	☐Faculty	☐Staff	☐Adjunct Faculty	☐Student

Department/Division:

TRIP DETAILS

Location:

Date of Departure:	Date of Return:

Please enter any personal time that will be used on this trip:

Purpose of Travel (i.e. conference name):

Please provide the URL to the conference website here:

Missed Classes & Coverage Information:

ESTIMATED EXPENSES AND FUNDING

Registration Fee: $

Airfare:$	Flight Details

Hotel: $	Hotel Details:

Transportation (to and from airport): $

Parking: $	Meals $

Personal Vehicle Mileage: $

Other: Notes:

TOTAL ESTIMATED EXPENSES: $

Trip will be funded by: ☐ Professional Development	☐Department	☐ Grant	☐ Other

Do you need help prepaying your expenses for this trip?	☐Yes	☐No

APPROVALS

Traveler’s (signature):	______________________________________________	Date:	_______________

Department Chairperson/Director (signature): ____________________________	Date:	_______________

Office of Academic & Student Affairs (signature): ________________________	Date: ________________