Dean's Office Travel & Training Request

Dean's Office Travel & Training Request
Dean's Office personnel are required to complete this form prior to travel, training, or submitting expense reimbursements >$300. Visit the Dean's Office Travel website:
https://medschool.ucla.edu/financial-affairs/deans-office-travel

Organizational Unit*

Event Title*

Business Justification*

Type justification for travel / training and benefit to the organization

Departure Date*

MonthDayYear

Return Date*

MonthDayYear

Requestor E-mail*

Email of person submitting request: example@mednet.ucla.edu

Supervisor Name*

First NameLast Name

Supervisor E-mail*

Email of person approving request must have been delegated budget authority

# of Employees Requesting Approval*

Please enter 1 if you are requesting training only for yourself

Attendee Name #1*

First NameLast Name

Attendee Name #2

First NameLast Name

Attendee Name #3

First NameLast Name

Attendee Name #4

First NameLast Name

Attendee Name #5

First NameLast Name

Additional Attendees

Type additional names here

Cost Estimation per Person

	Estimated Cost per Person	Payment Type	Comments
Airfare
Lodging
Parking/Taxi/Mileage
Registration/Certificate Fees
Guest Speaker/Lecturer Fees
Space/Equipment Rental
Meals (not included in registration)
Other

Total Trip Cost Per Person*

Add all Estimated Costs from the above Cost Estimation table

Is outside funding available (Yes/No)? If yes, please explain*

Will this request be funded by a gift, grant, or other outside funding?

Additional Trip Information

Upload a File

May include meeting agenda, trip schedule, etc.

Next Steps:

Once your request is approved, please attach approved form along with any required supporting documentation when submitting your Concur request.

Requestor Signature*

Use your computer mouse to sign your name in the space provided Clear

Attendee Details

Cost Details