Revised: 9/09/11(For Office Use Only)Assigned PeopleSoft Requisition Number:______

Initial Travel Request

Name:______Departure date: ______Return date:______

Destination(s) [City/State/Country]:______

Foreign travel: Please provide the name of the person(s) and institution(s)that you will be visiting and a breakdown of the dates for each visit.

Purpose of Travel: (Name of Meeting(s)/Event(s): ______

______

Personal/Vacation Date(s) if any: ______

(If any Personal/Vacation time is included, also submit a Notification of Absence form to the Biochemistry Office.)

Who will cover your work while you are away?______-A name must be noted, as required on the PeopleSoft Requisition.

List of Expenses: (Be as accurate as possible because the funds will be encumbered once this request is processed on the PeopleSoft Travel Requisition System.)

$______Airfare–Will you be using (UPT)university paid travelfor your airline tickets? __Yes __No

If yes, call one of the designated travel agencies: 1) Corporate Travel (366-1142) 2) The Alamo Travel Group (611-3461)

If you are not using UPT, you should pay with your State Issued Travel card.If you obtain a lower airfare rate than Corporate or Alamo Travel Agencies and pay with a personal credit card, you must obtain a verbal or email quote from one of these agencies. This quote needs to be noted on your travel voucher when it is submitted for reimbursement.

$______Rental Car $______Gas for Rental Car

$______Personal Car Mileage for In-City / In-State Travel. Current Texas reimbursement rate is .50¢ per mile.

$______Other Transportation: -Taxi, Shuttle or Train fare(s)

$______Lodging and Meals Per Diem for ______Days: OR ____Lodging only ____Meals only

$______Incidental Expenses such as standard hotel taxes, phone calls, internet fees, etc.

For In-State/ Out of State Travel Reimbursement Rates: please refer to the link to look up your destination.

Foreign Travel: There are no set per-diem rates.

Will your meals and lodging be included and paid on a registration package? ____Yes ____ No

$______Airport or Other Parking Fee(s) $______Baggage Fee(s)

$______Registration and/or Abstract Fee(s) -Provide a breakdown if claiming more than one fee). Prepaid with a Procurement Card? Yes/No____

Reminder: The Procurement Card can’t be used for a Registration Fee if it’s including payment for Lodging and Meals.

Expenses will be paid by: ___Grant funds – PID#______Host ___Personal funds

Will you be receiving aconsultant fee?___Yes ___No - If YES, please fill out the following form available on the UTHSCSA website.

-REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT, CONSULTATION, OR RELATED ACTIVITIES.

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Upon your Return, fill out aTravel Expense Form and Submit it with all your Original Receipts to the Biochemistry Office Staff.

All Receipts Needed: For Registration/Abstract Fees, for a (Non-UPT) Airfare, Baggage Fee(s), Taxi/Shuttle/Train Fares, Car Rental, Gas for Car Rental, Parkingfees,Meals and Itemized Hotel receipt with incidental fees such as room taxes/fees, Internet fees, etc.

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Person Requesting Travel Principal Investigator OR Department Chairman

Authorized Signature on Project ID#