Bernards Township School District, Mileage Reimbursement Tracking Form

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Bernards Township Public Schools
101 Peachtree Road
Basking Ridge, NJ 07920
(908) 204-2600 | (908) 766-7641 FAX
Mileage Reimbursement Tracking Form
When seeking mileage reimbursement, in accordance with the agreement between the Bernards
Township Board of Education and the BTEA, the employee should complete a mileage form indicating
dates and destination of travel. Use the chart below for mileage between schools. Please see complete
instructions and processing on the reverse side before submitting form.
Mileage for (dates): _________________________________
Date
From
To
Return to
Total Miles
Mileage Between Sites
Employee Name: ___________________________________
WA LC OS RH CH MP
Employee Signature: ________________________________
WA
2.2 2.5 1.5 1.8 5.4
Supervisor Signature: ________________________________
LC 2.2
4.3 3.6 3.2 3.2
OS 2.5 4.3
1
1.7 7.6
Rate: $0.31
RH 1.5 3.6
1
0.8 6.6
Reimbursement: $_____________
CH 1.8 3.2 1.7 0.8
6.4
MP 5.4 3.2 7.6 6.6 6.4

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