Travel Expense Reimbursement Form

Travel Expense Reimbursement Form

All GCSD travel must have prior approval by your principal and/or program director by using the Trip Request Form (https://form.jotform.com/221184048058050). Included with this form please include an agenda for the event you attended that shows the dates/times of the event.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Location of Employment:*
Purpose of Travel*
Destination*
Departure Date*

MonthDayYear
Date
Return Date*

MonthDayYear
Date

Lodging (All attempts should be made to use state-contracted lodging)
Lodging

Every attempt should be made to secure a room at the State contracted rate. Overnight lodging is only approved for trips over 100 mile and/or for multiple days. Receipts are required to be reimbursed for lodging. A rate of $45 per night will be paid for overnight stays with family, friends, or elsewhere.
Name of Motel/Hotel:
Number of Nights Stayed
Total Cost for All Nights:

Meals
Meals

No reimbursement will be made when a meal was available to the employee (continental breakfast, meals at an event, etc.) whether the employee ate the meal provided or not. An employee must leave before 6:00 AM to claim breakfast. An employee must return home after 6:00 PM to claim a dinner. Alcoholic beverages are not reimbursed.
Meal Per Diem Rates:
$16.00 - Breakfast,
$19.00 - Lunch,
$28.00 - Dinner

Were your meals in-state or out-of-state:
  In-State   Out-of-State

How many breakfasts should be reimbursed for this trip:   Number   .

How many lunches should be reimbursed for this trip:   Number   .

How many dinners should be reimbursed for this trip:   Number   .
Total Meal Reimbursement

Other Expenses (Registration Fees, Parking, etc.)
Registration Fees:
Parking Fees:
Other Fees:
Please describe other fees:   Type a label

Totals, Coding, and Receipts
Which program and code are you travelling under (e.g. SPED, Early Literacy, Adult Ed.) If not known, leave blank.
Total Reimbursement Request*
Upload Receipts

Cancelof
Should be Empty:

Lodging