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Travel Reimbursement Form

Travel Reimbursement Request

Traveler Name*
First Last
Traveler Email*
Enter Email Confirm Email
Traveler Affiliation*
Traveler Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Departure Date
MM slash DD slash YYYY
Departure Time

: Hours

Minutes

AM/PM
Return Date
MM slash DD slash YYYY
Return Time

: Hours

Minutes

AM/PM
Did your trip include any personal days?*
- Yes
- No
Destination
Date(s) Location Purpose
Did you submit a pre-trip Travel WebForm on Travel.uconn.edu?
- Yes
- No
Did you receive a UConn Travel Award?
UCPEA, AAUP, OVPR, etc.
- Yes
- No
UConn pre-paid for the following expenses:
Expenses that were booked with Sanditz, KFS, or ProCard
- Registration
- Lodging
- Rental Car
- Bradley Airport Parking
- Flight
- Baggage
- Train
I am requesting reimbursement for the following expenses:*
Select all that apply
- Registration
- Lodging
- Meals (based on per diem rate for destination)
- Meals (based on actual meal cost - must submit receipts)
- Flight
- Baggage
- Mileage (Personal Car)
- Rental Car
- Rental Car Fuel
- Shuttle
- Taxi
- Train
- Bus
- Ferry
- Business Expense (i.e. copier, fax, printing, postage)
- Other
Reimbursement Request
This calculation does not include meals or mileage
Name
This field is for validation purposes and should be left unchanged.

Date(s)	Location	Purpose

Travel Reimbursement Request

Destination