CITY OF WEST DES MOINES

TRAVEL AND TRAINING REQUEST

Department / Today’s Date
Employee(s)
Name(s) / Sponsoring Organization/ Activity Name
Position(s) / Location
Travel/Training A/C # / Travel/Training Dates

1.  Summarize Purpose and Content of Travel/Training Activity. (Please attach a copy of the program content. Include any intention of participating in pre or post event activities)

2.  Indicate any specific City wide benefits: (Please check as appropriate)

City Will Be Responsible For Travel Costs City’s Contribution May Be Limited

o Trip is In-State o Trip is Out-of-State

o Trip at the request of Elected Officials or the City Manager’s Office o Optional Training or Conference

o Required Training (ex: Professional Certification, Request of Dept.) o Other (Explain benefit of trip)

o Member of National or State Board or Committee

Based on the selections above, the travel request may be denied or the employee may be reimbursed a limited amount of expenses associated with the trip. The costs above the limitation would need to be covered by the employee. Current reimbursement limitations are $250 for travel (air travel or mileage reimbursement) and $150 per night plus taxes for Lodging plus Local Transportation (taxis or rental).

3.  If this is an unbudgeted request, please state how the Department plans to cover the cost of this request. (For instance an internal budget transfer, foregoing a specific budgeted event, etc. In the case of an internal budget transfer, please attach a copy of the authorized transfer.)

4.  Travel/Training Expenses: (Please Itemize)

Registration $ Other Expenses $

Lodging $ Total Expenses $

Travel $ City’s Responsibility $

Meals $ Employee’s Responsibility $

Other Sources (ex: grants) $

5.  Are there multiple employees attending this same event (and if so, who?).

6.  Authorization: (For in-state travel/training approval of the Department Director is required. For out-of-state travel/training, the request is to be reviewed by the Finance Director with approval by the City Manager or Admin. Board).

Initial Date
Department Director / I believe the above request meets a public purpose and the costs are reasonable.
o Yes o No o Modify:
Finance Director / As of this date, funds are available for this request.
o Yes o No o Modify:
City Manager Authorization / o Yes o No o Modify:

Copy to: Department

Employee

Finance (original with required attachments)

C:\Documents and Settings\ssanders\Desktop\Travel_and_Training_Request_Form.doc