White River School District s1

White River School District

Prior Approval and Memorandum of Understanding

In accordance with Board Policy #6213, prior approval must be on file in the Business Office for any out-of-district work-related travel, or professional leave requiring a substitute. This form is not required when only mileage and parking are being submitted.

(Out-of-State travel requires School Board approval and must be submitted thirty days prior to departure.) Out-of-State Board Approval (approval date): ______

To claim reimbursement, use the Monthly Reimbursement Report. Personal travel or expenses are not reimbursable. Meals will only be reimbursed when you are on Travel Status. Travel Status is defined as when a traveler is away, on district related business, which requires an overnight stay. Meals and incidentals shall be reimbursed at the per diem allowance established by the U.S. General Services Administration (GSA) at the rate in effect for the primary destination. You can access that rate information at www.gsa.gov/perdiem.

Name: Work site: Today’s date:

*Name of event (full name):

Location of event (provide complete address):

Dates of absence:

*Does any part of the Event or Hotel provide a meal? Yes No

IF yes, list all meals that are provided by day:

______

Substitute Required Yes No Sub Dates:

Budget code for sub:
Sub authorization code:

Purchase Order(s) associated with trip: #

Are you using your Staff Development/Classroom Materials Allocation? Yes No

Budget code– please complete

$ / Registration / ______7049______
$ / Workshop materials / ______5000______
$ / Mileage @ x ______miles / ______8048______
$ / Lodging / ______8049______
$ / Car Rental / ______8049______
$ / Airfare / ______8049______
$ / Meals/Incidentals - per diem– 75% departure day rate – www.gsa.gov / ______8049______
$ / Meals/Incidentals - per diem whole day rate– www.gsa.gov / ______8049______
$ / Meal deduction by date: / ______8049______
$ / Other (note) – i.e. parking / ______8049______
$ / Total Expenses

I have read and understand the above conditions:

______

Signature Date

______

Supervisor Signature Date

______

Budget Manager Signature Date

Original signed copy to Business Office – retain copy for employee reimbursements Rev: 9/12