TRIP EXPENSE REIMBURSEMENT FORM
(Between 6:00 a.m. and 7:00 p.m.)
Board Member
Classified
Certificated
Parent
Claimant's Name:
Department:
Auto Being Driven in Performance of Duty: License #:
Make:
Sponsoring Organization:
Submit no later than 2 weeks after workshop.
Destination
Allowed
Date
Workshop/Purpose
Expenses
Expenses
Hours of Workshop
$
Breakfast
$
Lunch
$
Dinner
$
Books, Etc.
$
Other
$
$
Subtotal
$
0.00
Miles
Paid at $.575 Per Mile
$
Total
0.00
$
AUTHORIZED ALLOWANCES FOR WORKSHOPS
*Workshop fee paid by participant (with prior approval for attendance), parking, bridge tolls, taxi, books, etc., when receipt
is attached.
Meal or Meals**
Breakfast: Breakfast may be claimed if travel/meeting began at or prior to 6:00 a.m. and terminated at or after 9:00 a.m.,
not to exceed $7.00.
Lunch:
Lunch may be claimed if travel/meeting began at or prior to 11:00 a.m. and terminated at or after 2:00 p.m.,
not to exceed $11.00.
Dinner:
Dinner may be claimed if travel/meeting began at or prior to 5:00 p.m. and terminated at or after 8:00 p.m.,
not to exceed $23.00.
**If the meal or meals are included as part of the registration fee, please check which were applicable:
Breakfast
Lunch
Dinner
Claimant's Signature:_______________________________________
Date: ___________________
Department Head Approval: __________________________________
Program #:
_________________________________________
_
YCOE 3851 (02/06/2014)