Please
complete all relevant
portions of this form. For questions
concerning travel contact: Carolyn Wooley, 6-3158 or cwooley@uoregon.edu
Name: Date Submitted
Home Address:
(Required for travel
reimbursement)
Destination(s): Travel Dates:
NATURE OF PROFESSIONAL ACTIVITY
1.
Conference Participation (NOTE: Upon return submit a conference
brochure showing the agenda, conference dates and any meals/banquets/hosted events as part of
the conference.)
Name of conference: Location and dates:
(No acronyms!)
2.
Other (Provide business purpose: start and
end date(s), location, names and affiliations of individuals consulted, or
places/ monuments, institutions visited, description of activity, and benefit
to university. May need to be clarified
upon return for reimbursement purposes.)
TRAVEL INFORMATION
1. Will
you travel while on sabbatical or another type of leave?
No Yes. (I have attached a prepared Sabbatical Travel Approval Request form.)
2. Will you combine business and personal travel
on this trip?
No Yes. (I will provide a quote from one of the
three contracted agencies showing the cost of the business travel portion only
at the time of ticket purchase.)
3.
Mode of Main Transportation: (NOTE: Mode of transportation should be the most economical one suitable for
the purpose of the trip.)
a. Air
Transportation (coach/economy,
no first class)
Date ticket required: OR
ticketing date:
·
Contracted travel agency/agent’s
name:
Away/Azumano
(687-2250) Ambassador
(686-1234) Premier
(747-0909)
·
Other/Agent’s name (if
available) and name of agency, or airline, or internet service:
Agency Internet travel service Commercial
airline
b. Other (NOTE:
If you are traveling out of state on routes served by common air carriers but
using other than air transportation, an airfare quote for the same itinerary
must be obtained from one of the three contracted travel agencies.
Reimbursement will be for the least expensive means of transportation taking
into consideration cost of conventional terminal transportation.)
Rental Car (must be economy unless 3 or more travel
together)
Agency name: (NOTE: Limited Damage Waiver (LDW) is required for all car rentals except if using state agreement with
EXPENSE AND FUNDING INFORMATION
Expenses
(estimates where
necessary)
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Funding Sources (specify index if possible) |
Index (if known) |
Amount |
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Airfare |
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Department Allocation |
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Mileage _______ mi. @$.445/mi: |
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ASA
/ ASA Match |
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Ground Travel (shuttle, taxi, etc.) (Receipts required if over $75, no
reimbursements for tips) |
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Other Funds (specify) |
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Registration Fee |
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Support
from other Academic Departments (Provost,
etc.) Provide documentation! |
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Lodging* (see below) |
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Meals* (complete itinerary below) |
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Miscellaneous (parking, phone calls etc.) (Receipts
required if over $25 for reimbursement) |
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Research Fund |
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Total: |
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Total (must match expense total) |
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Availability of
Funds Verified |
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* If claiming Lodging or Meals please complete
itinerary below. (NOTE: Upon return you
must present a hotel receipt with your name, dates of occupancy, and a zero due
balance amount for reimbursement.)
Itinerary:
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Date |
Hour of Dept. |
Hour of Arr. |
Destination |
Breakfast $ |
Lunch $ |
Dinner $ |
Lodging $ |
Conference Hotel? Y/N |
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TOTALS |
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Meal Rates (effective 11/01/05): Lodging Rates (effective 11/01/05):
In-state and low cities: $11.25/breakfast, $11.25/lunch, $22.50/dinner In-state and low cities: $96, high cities: $168
High cities;
$14.50/breakfast, $14.50/lunch, $29.00/dinner Foreign
city rates vary
Foreign
rates vary If
conference hotel, use conference hotel rate.
Calculation Comments:
TRAVELER’S SIGNATURE Date
SUPERVISOR
APPROVAL Date
Philosophy
Travel Approval
Supplemental Information
Name: _______________________________
Dates: _______________________________
What, if any, classes will you miss because of this trip?