LTAI Scholar Reimbursement Form FY26

Disbursement Form - ICfL Staff Use Only
LTAI Scholar Travel Reimbursement
Project Number:
Project Title:
Fund:
Funding Source:
Appropriation Unit:
Account Code:
Invoice Number (LTAI SCH YY-nnn)
Check / Invoice Description:
Staff Approval Signature:
Scholar Reimbursement

Please submit a reimbursement form for each LTAI session
Before completing the form, please:
- Review the ICfL's Scholar Invoice Rates & Instructions for reimbursement guidelines and allowable expenses
This form must be submitted within four weeks of the LTAI session.
Claimant Information
Make Check Payable to:
Mailing Address of Individual Receiving Check:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Full Name of LTAI Scholar
Library hosting the LTAI session (choose one):
You must submit a separate form for each event attended.
Scholar email address:
example@example.com
Scholar phone number:

Area CodePhone Number
Date and time of LTAI session

MonthDayYear
DateHourMinutesAM/PM Option
Would you like to claim a $250 speaker fee for this session? If yes, select 250:
I would like to claim meal/travel/lodging costs
Travel Details
Mode of Travel
Ground Travel
Mileage:

Use Google Maps to calculate mileage.

Mileage and drive time are calculated from your home city to the location you did your LTAI presentation. Use the shortest, safest route.
ONE-WAY Mileage from home city to LTAI presentation site *Use Google Maps
Enter one-way mileage
Total Mileage (automatically calculated)
Mileage Reimbursement Amount Claimed (automatically calculated, do not enter a value)
Mileage Claimed multiplied by $0.70/mile.
Air Travel
Airfare cost:
Upload receipt below
Baggage fee:
Upload receipt below
Shuttle/taxi to and from airport to event (if not provided by hotel):
Upload receipt below
Receipts must be received within two weeks of submitting this form.
Upload receipts (if possible, scan all receipts into one file, then upload)

Browse Files
Individual files are also accepted: pdf, doc, docx, jpg, jpeg, png. If you cannot get this widget to work, you can email receipts to the ICfL staff person who coordinated your event. Cancelof
Mileage to and from airport:

Use Google Maps to calculate mileage and drive time for questions below.

Mileage and drive time are calculated from your home address to airport. Use shortest, safest route.
ONE-WAY Mileage to airport from my home address, according to Google Maps:
One-Way
ROUND-TRIP Mileage to Airport (Automatically Calculated, DO NOT ENTER A VALUE):
Mileage Reimbursement Amount to/from Airport (automatically calculated, do not enter a value)
Lodging

Lodging will be reimbursed at actual cost. An itemized receipt issued by the hotel showing check-in/check-out dates is required (not a credit card receipt). Lodging should be secured at standard rates for the area. Unusually expensive/luxury accommodations or excessive lodging costs (such as additional rooms for family members) are not allowable. The ICfL will not reimburse travelers for additional expenses such as in-room movie rentals, laundry services, or room service.
Did you require lodging?
Total lodging reimbursement amount you wish to claim:
This amount needs to be reflected in the receipts
Lodging receipts must be received within two weeks of submitting this form.
Upload receipts (if possible, scan all receipts into one file, then upload)

Browse Files
Individual files are also accepted: pdf, doc, docx, jpg, jpeg, png. If you cannot get this widget to work, you can email receipts to the ICfL staff person who coordinated your event. Cancelof
Meal Stipend

I would like to claim the following meals *Please refer to the chart above to make sure you qualify for each meal.
Total meal reimbursement (automatically calculated, do not enter a value):
Please include any comments or clarification regarding your travel-related reimbursement, if needed:
Miscellaneous Expenses: These expenses must be cleared with the ICfL BEFORE they are incurred.
In-Kind Match Hour

Scholars are asked to contribute their time spent preparing for and traveling to each session as an “in-kind” donation to the program. The ICfL will calculate the estimated value of these hours and will report this as an in-kind match as required by funders and other partners. You will not be reimbursed for in-kind hours.
How many hours did you spend preparing for the LTAI session?
Program prep will be calculated at a rate of $50 per hour.
How many hours did you spend traveling to and from the program?
Travel time will be calculated at a rate of $10 per hour.
Signature
Don’t forget to submit a LTAI Scholar Feedback Form after each session. Payment may be delayed or held until a feedback form is completed.

If you have any questions about this form, please contact LeAnn.Gelskey@libraries.idaho.gov

Itemized Expenses:

Mileage Reimbursement Total: ${mileageReimbursement}	Airfare: ${airfareCost}
Meal Stipend: ${totalMeal}	Baggage Fee: ${baggageFee}
Speaker Fee: ${wouldYou}
Lodging: ${totalLodging}	Shuttle from airport to event: ${shuttletaxiTo}
	Mileage Reimbursement Amount to/from Airport: ${mileageReimbursement88}

Total Reimbursement Claim:
Travel Total:
Your typed name in the box below serves as your signature.

First NameLast Name
When you click "submit" you will receive an email copy of this form.
Should be Empty:

Meal	Rate	On Departure Date	On Return Date
Breakfast	$14.50	Must leave home before 7 a.m.	Must arrive home after 8 a.m.
Lunch	$20.30	Must leave home before 11 a.m.	Must arrive home after 2 p.m.
Dinner	$31.90	Must leave home before 5 p.m.	Must arrive home after 7 p.m.

Disbursement Form - ICfL Staff Use Only

Scholar Reimbursement

Claimant Information

Travel Details

Ground Travel

Air Travel

Lodging

Meal Stipend

In-Kind Match Hour

Signature