Dean's Office Travel & Training Request

Dean's Office Event, Travel & Training Request
Dean's Office personnel are required to complete this form prior to travel, training, or submitting entertainment or other expense reimbursements. Visit the Dean's Office Travel website:
https://medschool.ucla.edu/financial-affairs/deans-office-travel
Organizational Unit*
Event / Training Title*
Please note any internal meetings, staff retreats, or social activities will not be approved
Explain why this expense is essential and the most cost efficient option*
Is this the minimum necessary to achieve the goal?
How is this event or training clearly essential and immediate to one or more of the following mission areas? What is negative impact if denied?*
Accreditation, compliance, curriculum, research productivity, clinical care, public service
Departure Date or Event 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 be delegated budget authority
Attendee Details
# of Attendees or Employees Requesting Approval*
Enter 1 if you are requesting training only for yourself
Attendee Name

First NameLast Name
For multiple attendees, upload a file of all attendee names

Upload a File
Required if more than one person attends Cancelof
Cost Details

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)
Breakfast (if event; cap $31/pp)
Lunch (if event; cap $54/pp)
Dinner (if event; cap $94/pp)
Light Refreshments (if event; cap $22/pp)

Total Cost Per Person*
Total Event Cost*
Add all Estimated Costs from the above Cost Estimation table
Venue or Vendor Name*
Is outside funding available (Yes/No)? If yes, please explain*
Will this request be funded by a gift, grant, or other outside funding?
If using restricted funding, provide budget detail to show this is an allowable expense

Upload a File
Restricted includes gifts, grants, contracts Cancelof
Fund Source / Fund Number*
Total # expenses this individual / group will request this fiscal year*
i.e. 3 graduation expenses
# expense out of the total*
i.e. request 2 of 3
Explain how you have explored lower-cost alternatives (e.g., virtual attendance, internal venues, less expensive catering, etc.). Is this the lowest cost viable option?*
i.e. using internal UCLA catering, exploring local conferences, etc.
Invoice / Cost Estimate

Upload a File

Cancelof
Additional Trip Information

Upload a File
May include meeting agenda, trip schedule, etc. Cancelof
Please confirm that your request falls within policy limits. Any requests that exceed policy limits will be rejected.

See caps and policies here: https://travel.ucla.edu/policy-resources/reimbursement-allowances-mileage-meals

Once your request is approved, please attach approved form along with any required supporting documentation when submitting your Concur or Procurement Portal request.
Requestor Signature

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

For Management Use Only
The supervisor signing this form agrees that he/she has budget authority to authorize the expenses requested.
Supervisor Password
Supervisor Name*

First NameLast Name
Supervisor Approval*
Comments
By signing, you confirm that these expenditures are cost effective and in accordance with the best use of public funds in accordance with UC policy. All available options to reduce costs have been considered.
Supervisor Signature*

For CAO / Finance Use Only
The CAO or delegated signing this form agrees that he/she has budget authority to authorize the expenses requested.
CAO / Delegate Password
CAO or Delegate Name*

First NameLast Name
CAO or Delegate Email*
example@example.com
CAO or Delegate Approval*
Comments
Should be Empty: