Mileage Reimbursement Form
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1Business Office Use Only
VOUCHER #_____________
DATE:__________________
CHECK #________________
EASTERN WYOMING COLLEGE
MILEAGE REIMBURSEMENT FORM
1. This form is to be used for requesting reimbursement for mileage. Travel reimbursement for mileage
when using your personal vehicle requires a record of miles traveled. Supervisor approval is required
for the use of personal vehicles. To claim the $0.48 per mile rate, supervisors must verify that no
appropriate college vehicle was available from the EWC Motor Pool. If an appropriate vehicle was
available and you chose to use a personal vehicle, mileage will be reimbursed at the $0.28 per mile rate.
2. Complete this form and return to the Business Office when travel is completed.
NAME ____________________________POSITION __________________________________
CURRENT ADDRESS____________________________________________________________
DESTINATION _____________________PURPOSE __________________________________
MILEAGE
STARTING
ENDING
DATE
DESTINATION
ODOMETER
ODOMETER
MILES
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
________ _______________________
______________
________________ ________
TOTAL MILES
________
Miles X Rate ($0.28 or $0.48)
TOTAL $ ________
BUDGET NUMBER _ _ - _ _ _ - _ _ _ _ _ _ - _ _ _ _
BUDGET NUMBER _ _ - _ _ _ - _ _ _ _ _ _ - _ _ _ _
___________________________________
______________________________
Division Chair/Supervisor Signature
Claimant Signature
Date:_____________________
Effective 12/12/07
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