Travel Reimbursement Form
INSTRUCTIONS
Please attach all receipts electronically to this form. If you are claiming toll or other charges for reimbursement, you must attach your receipt(s) of payment.
Mileage rate is
$0.47
per mile.
SECTION III must be filed out for board approved workshop and conferences.
Images taken thru cell phone devices, tablets are not accepted. Please scan your receipts via a copy machine and attach your original receipts to this form. Please be aware that payments will not be released without the original receipts.
Please review our
Travel Reimbursement Policy
Please review your school's board meeting dates at your campus' respective site under Board of Trustees tab.
Section I
Employee Name
*
First Name
Last Name
Employee Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Request
*
-
Month
-
Day
Year
Date
Location
*
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Primary
Bronx Elementary
Central Office
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City Primary
Section II
Start Date of Program
*
-
Month
-
Day
Year
Date
End Date of Program
*
-
Month
-
Day
Year
Date
Purpose/Explanation
*
Destination
*
Mileage
*
Parking Fee
Toll Charge
*
Other
Total Cost
Section III - Report of Travel
Workshop/Conference Title
*
Primary Purpose
*
Key Issues
*
Relevance to Improving Instruction
*
Upload Receipts
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Email
example@example.com
Signed On
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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*
Submit
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