Dependent Care Travel Award User Report
Name:
*
First Name
Last Name
Email Address:
*
Conference/Research Meeting Name:
*
Start Date:
*
/
Month
/
Day
Year
Date
End Date:
*
/
Month
/
Day
Year
Date
Add additional conference/research meeting?
Please Select
Yes
No
Conference/Research Meeting Name #2:
*
Start Date:
*
/
Month
/
Day
Year
Date
End Date:
*
/
Month
/
Day
Year
Date
Add additional conference/research meeting?
Please Select
Yes
No
Conference/Research Meeting Name #3:
*
Start Date:
*
/
Month
/
Day
Year
Date
End Date:
*
/
Month
/
Day
Year
Date
Breakdown of Expenses:
*
Conference/Research Meeting #1
Conference/Research Meeting #2
Conference/Research Meeting #3
Childcare
Lodging
Travel Expenses
Other
TOTAL
Please upload proof of attendance and proof of expenses.
Browse Files
Cancel
of
Policy Attestations (please check the boxes to confirm):
*
I confirm that I have read and accept the Dependent Care Travel Awards Use and Policies.
I confirm that the reimbursement does not supplant existing dependent care scheduled during the travel dates but supports care needs beyond regularly scheduled dependent care.
Please briefly let us know how the Dependent Care Travel Award benefited your career:
Optional: Do you have any feedback for the Office of Academic Personnel about the Dependent Care Travel Awards?
Submit
Clear Form
Updated 10/2024
Should be Empty: