Travel Reimbursement Check List Template
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1Travel Reimbursement Check List
COE/CIS FTC
Attach: travel receipts
revised 3/2/11
Send check to
Travelers Name:
mailing Address:
Staff
Student
or
Faculty
I have ACH (Direct Deposit)
Net ID:
Phone:
(To Enroll, go to:
processing/reimbursements/achselfenroll/index.cfm for more info)
Destination:
Trip Dates:
Research / Business Purpose of Trip (who, what, why, when, where). Please do not use acronyms.
**If this reimbursement is being charged to a sponsored account please be sure to include how the travel directly relates to the scope of the
project.
If no, how was it arranged?
Are you requesting reimbursement for transportation?
No
Yes
Airfare
Personal Vehicle, # miles driven:
Rental Vehicle
Bus/Train
Other:
Yes
Are you requesting reimbursement for lodging?
If no, where did you stay?
No
How would you like to be reimbursed for meals?
Submit Receipts
Per Diem
No Meals
Were any meals provided? If yes, list date(s) and meal(s):
Do you have any "unreceipted" expenses? (Under $75; allowed: taxi, subway, tolls, etc.) If yes, please list and explain:
*receipts should be provided whenever possible*
Expenses prepaid by Cornell (not
Airfare
Conference Registration
Hotel
Other:
reimbursable) ie: paid on pcard
Did you receive
No
Yes
Did you take a
No
Yes
Amount:
reimbursements from other
travel advance?
Amount:
organizations/departments?
Comments:
Is there a funding limit?
No
Yes
Account #:
Amount:
If sponsored, are these federal funds?
No
Yes
Department/Unit use only
Prepared by:
Account Approval:
OR
net id/name
Add as a viewer in travel system (Net ID)
Students/Staff MUST provide faculty sponsor, advisor or supervisor name and netID
Supervisor name:
Net ID:
Approval Signature:
Attach this check list to receipts and forward to your Department/Unit.
Print Form
Department/Unit will forward to FTC Representative, 484 Rhodes Hall
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