Simple Travel Authorization
Trip Title
Name
*
First Name
Last Name
Program(s)
Reason For Trip
*
Destination
*
Departing
*
-
Month
-
Day
Year
Date
Returning
*
-
Month
-
Day
Year
Date
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Travel Information
Mode Of Travel
*
Air/Train
Driving Car
Riding in Car
Driver?
Number of Miles To Drive
*
Mileage Cost (58.5 cents per mile)
Airline(s)/Train-line(s)
*
Total Ticket Cost
*
Are You Renting A Car
Yes
No
If you are renting a car, you must add basic insurance to the order.
Cost Of Car Rental
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Hotel Information
Hotel Name
*
Hotel Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Per Diem Rate
*
Nights at Hotel
*
Nightly Rate
*
Hotel Cost Total
Is Your Nightly Rate Above Per Diem
*
Yes
No
Do You Request Special Reimbursement Authorization
*
Yes
No (You will only be reimbursed the Per Diem Rate)
Why Does Your Nightly Rate Exceed Per Diem
*
Est. Trip Cost (excluding taxes)
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Summary
Should be Empty: