Clone of BOARD MEMBER Expense Report Submission

Expense Report Submission

For Reimbursement
CLE Trainer
Full Name

First NameLast Name
Email Address
example@example.com
phone #
Format: (000) 000-0000.
Submission Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Period: Beginning

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Period: Ending

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TRAINING HELD IN

Please list location(s) below
Training Location 1
Division(s) Trained
Date of Visit

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address (Starting Point)

Street Address

City
City (Visiting Division)
Mileage: Automobile (Input Roundtrip Miles)
Calculated at $0.52 per mile
Total Mileage Expense
Training Location 1
Training Location 2
Division(s) Trained
Date of Visit

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address (Starting Point)

Street Address

City
City (Visiting Division)
Mileage: Automobile (Input Roundtrip Miles)
Calculated at $0.52 per mile
Total Mileage Expense
Training Location 2
Training Location 3
Division(s) Trained
Date of Visit

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address (Starting Point)

Street Address

City
City (Visiting Division)
Mileage: Automobile (Input Roundtrip Miles)
Calculated at $0.52 per mile
Total Mileage Expense
Training Location 3
MILEAGE SUPPORTING DOCUMENTATION

Mileage Supporting Statement Required
Please enter the mileage details for each trip included in your reimbursement request
Mileage Trip 1
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Destination/Club
Purpose
Mileage Beginning
Mileage Ending
Total Mileage
Do you have a 2nd mileage trip to report?
Mileage Trip 2
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Destination/Club
Purpose
Mileage Beginning
Mileage Ending
Total Mileage
Do you have a 3rd mileage trip to report?
Mileage Trip 3
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Destination/Club
Purpose
Mileage Beginning
Mileage Ending
Total Mileage
Hotel and Other Expenses

Must be pre-approved by CLE Chairman
Hotel (# of days)
Hotel $
Other Expense $
Description of Other Expense
TOTAL Hotel and Other Expense
Include Hotel and Other Expense Receipt(s)
TOTAL EXPENSE REIMBURSEMENT REQUEST
Supporting Documentation – Required

Please attach supporting documentation for all expenses included in your reimbursement request.

Mileage: Driving directions map.
Other Expenses: Receipt, invoice, hotel folio, registration confirmation, or other documentation supporting the expense.

Reimbursement requests submitted without the required supporting documentation may be returned for additional information.
By submitting this form, I certify the expenses are actual.

I have attached supporting receipts, if applicable
Mail Reimbursement To
Make Check Payable To

First NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Treasurer Email Address
example@example.com
Treasurer Review
Accountant Email Address
example@example.com
Treasurer Comments
Accountant Review
CNH Office Comments
Upload Receipts or Supporting Documents

Cancelof
Should be Empty:

Expense Report Submission

CLE Trainer

TRAINING HELD IN

Training Location 1

Training Location 2

Training Location 3

MILEAGE SUPPORTING DOCUMENTATION

Mileage Trip 1

Mileage Trip 2

Mileage Trip 3

Hotel and Other Expenses

Mail Reimbursement To