GADSDEN STATE COMMUNITY COLLEGE
REQUEST FOR IN STATE TRAVEL
Reimbursed for actual expenses
President
Gadsden State Community College
H/1.1-A
Please Type Attach Program/Agenda of Event to Attend
Date of Request
Request is respectfully made for authorization of travel for the purpose of attending a conference/meeting of a state/national organization in which the state/individual is a dues paying member.
Name of State/National Organization
Where dues paid by individual/institution
Amount of dues paid
Description of event attending
In the city of , ALABAMA
Mode of Transportation
Lodging (specify hotel if known) Date of Departure
Date of Return
ESTIMATED COSTS:
Transportation/Mileage Registration Fee
Signature
Room Type or Print
APPROVED:
Meals
Taxi/Car Rental
Department/Division Chairman
Total Executive Staff Member
President
I, the undersigned employee, verify that any prepaid expenses are for travel on official State business. In the event I do not make the trip for any reason, I agree to reimburse the college for any pre-payment made on my behalf.
The authority to receive actual expenses is based on attendance of conference/meeting of a state/national organization in which the state/individual is a dues paying member.
Employee Signature:
GADSDEN STATE COMMUNITY COLLEGE
IN STATE ACTUAL TRAVEL REIMBURSEMENT FORM
Department
Vendor ID# G Payee
Address
RECAPITULATION OF EXPENSES
Account / Amount / Necessary Expenses incurred in connection with travel7500 / $ / In State Mileage
7501 / $ / In State Commercial Transportation
7503 / $ / In State Other Travel Expense (Meals and Lodging)
7504 / $ / In State Registration
Total Travel Expenses / $
GADSDEN STATE COMMUNITY COLLEGE
IN STATE ACTUAL TRAVEL REIMBURSEMENT FORM, PAGE 2
Payee Department
Itemized Statement of Necessary Traveling Expenses Incurred for Period to Add Each Column and Carry Totals Forward to Recapitulation on First Page
Transportation Expenses - List dates of transportation expense and detail of expense.
DATE / FROM / TO / Hour Depart Base Hour ReturnBase / Miles if Private Car / Fare or Mileage Rate .535
Total / $
Meals, Lodging and Emergency and Necessary Expenses - List all dates of travel, expenses incurred on each date and detail of expense.
List Each Date of Travel / Breakfast / Lunch / Dinner / Total Meals / Lodging / Meals and Lodging / Misc. / Detail of Misc. ItemsTOTALS / $ / $ / $ / $ / $ / $ / $
Note tips paid in restaurants on meal receipts. When listing meal costs above, include tips in the costs.
GADSDEN STATE COMMUNITY COLLEGE
IN STATE ACTUAL TRAVEL REIMBURSEMENT WAIVER
Pursuant to Act 2017-409 approved 5/26/2017 by Governor Kay Ivey.
The authority to receive actual expenses is based on attendance of conference/meeting of a state/national organization in which the state/individual is a dues paying member.
I hereby waive my right to claim actual expense reimbursement and claim per diem reimbursement for the travel listed below.
Name of State/National Organization
Date of Travel
Event Attended
Printed Name Signature
Approved Date