REQUEST FOR TRAVEL REIMBURSEMENT - DCI '00: July 10 - August 4, 2000

Requester's Name: _____________________________________________________________________
Home Address: _____________________________________________________________________
_____________________________________________________________________
E-mail Address:_________________________________ Date of Travel/Visit(s): ________________
Please explain how this expense relates to funded project:
__________________________________________________________________________________
__________________________________________________________________________________
From:________________ To:________________
TRANSPORTATION: AMOUNT
  • Airfare (Original plane ticket must be attached)
 $___________
  • Train (Original train ticket must be attached)
$___________
  • Mileage: _________ miles round trip @$0.25/mi.
    (Personal car use)
$___________

LOCAL TRANSPORTATION (Attach all original receipts)
  • Taxis, limos, buses
 $___________

ACCOMMODATIONS
  • Lodging (Original receipts required - Credit Card receipts alone cannot be accepted)
$___________
  • Meals (Attach all original receipts - no stubs allowed)
$___________

OTHER EXPENSES (Attach all original receipts)
  • Tolls
$___________
  • Parking
$___________
  • Registration
$___________
  • Other (Please Explain) _________________________________
$___________
Requester: _________________________________ Date Submitted: ________________________
Signature
Return reimbursement form and receipts to:
DIMACS, CoRE Bldg., Rm. 406
Rutgers, The State University of New Jersey
96 Frelinghuysen Road
Piscataway, NJ 08854-8018
Attn: Financial Assistant

Questions? E-mail at financial-assistant@dimacs.rutgers.edu or call (732) 445-5928 (Note: reimbursements take approximately four weeks to process.)

For DIMACS Financial Department use only.

Approved by: _________________________________________ Date Approved: _______________