Official Visit Travel Voucher Form - San Jose State University Athletics Compliance Office

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San Jose State University Athletics
COMPLIANCE OFFICE
Official Visit Travel Voucher
Prospect Name:
Sport:
To Be Completed By Prospect
Did you drive to San Jose State University for your official visit?
Yes
No
Date of arrival:
Time of arrival:
Date of departure:
Time of departure:
Name of the person’s car in which you traveled?
To Be Completed By Sport
________________________ has been provided $__________ for mileage and/or expenses for
(Prospect Name)
travel between ________________ and San Jose, CA. The expenses provided are as follows:
(City, State)
Mileage: __________Miles @ $.445 per mile = $__________
*Please attach a Google Map of mileage traveled from prospect’s starting location to campus.*
Other Expenses (e.g., meals, lodging): $__________
*Please attach receipts for any other expenses incurred by prospect en route.*
Signatures
My signature below affirms that the above information is accurate and that I receive this money as
reimbursement for mileage and/or expenses incurred en route to/from my official visit to San Jose
State University.
Signature of Prospect
Date
My signature below affirms that I have provided the amount of money indicated above to the named
prospect as reimbursement for mileage and/or expenses incurred en route to/from the prospect’s
official visit to San Jose State University. Further, my signature affirms that to the best of my
knowledge the prospect, or his/her parents/legal guardians and/or other family member drove their
own vehicle to/from San Jose, and no other individual (i.e., high school football coach) drove.
Signature of Staff Member Providing Reimbursement
Date
Updated 6/11/13

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