Wsu Student Reimbursement Form
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1WSU STUDENT REIMBURSEMENT FORM
.
(For Travel or Other Non-Travel Misc Reimbursements
)
Student Name
_______________________________________________________________
Mailing Address
_______________________________________________________________
City, State, Zip
_______________________________________________________________
Phone Number
___________________________________
Tech ID#
___________________________________
Check one
Mail check to above address OR
Pick up in the Business Office
(this option for Student Clubs Only)
Cost Center Number(s) __________________________________
TRAVEL EXPENSES
OR Non-Travel REIMBURSEMENT
Dates of Travel ________________Destination
________________
$___________
Other (explain)
Transportation Reimbursement for personal car
_________________________________________
1. Mileage: Number of miles____@.505/mile
$________
_________________________________________
2. Or reimburse gas receipts
$________
_________________________________________
Airfare (if applicable)
$________
Lodging (Room and tax only)
$________
Meals (not to exceed $9 B, $11 L, $16D)
$________
Registration and Admission Fees
$________
Miscellaneous Travel Expense
$________
Other (explain)
$________
TOTAL TRAVEL EXPENSES
$
$
TOTAL NON-TRAVEL EXPENSES
GRAND
TOTAL $
Student Signature:
Date
Signature
Authorized Representative/Responsible Party for the Cost Center:
Date
Signature
Itemized paid receipts are required for all reimbursements, please attach.
Photocopies, canceled checks and photocopies of credit card bills do not substitute for itemized receipts.
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Parent category: Business