Fillable Printable H&SS Business Expense Reimbursement Request

H&SS Business Expense Reimbursement Request

H&SSBUSINESSEXPENSEREIMBURSEMENTREQUEST

INSTRUCTIONS

1.Completeallrelevantinformation.

2.Submittherequesttothedepartmentpreparerwithin30days ofincurringtheexpense.

3.Alloriginal,itemizedreceiptsmustbeattachedtothisrequest.

NAME:____________________________________________________________________________

CHARGETO:_______________________________________________________

BUSINESSMEALS

H&SSPolicyStatement: Businessmealsshouldnotexceed

75perperson,includingtaxandtip,for2‐5guests.

Forgroups>5thetotalcostshouldnotexceed$375.Ifyourdepartmentheadapprovedanexceptiontothislimit

priortothemeal,pleaseattachthatcorrespondence.Otherwise,thedepartmentheadmustapprovebysigningbelow.

DepartmentHead_____________________________________________________________

PURPOSE(Pleasecirclecategoryanddescribebelow.)

Forgroupsof5orless,providenamesandaffiliationofattendees.For6+,providetheheadcountandaffiliations

GuestSpeakerRecruitmentSpecialEventProfessionalCollaboration

Listexpensesbelowandattachitemizedchecksalongw

creditcardreceipts.Identifyalcoholonthecheck.

DATE DESCRIPTION AMOUNT

GENERALEXPENSES

Listexpensesbelow,includingpurposeofitems,andattachitemizedreceipts.

DATE DESCRIPTIONANDPURPOSE AMOUNT

REQUESTOR'SSIGNATURE

Tothebestofmyknowledge,thisrequestcomplieswiththeUniversityBusinessandTravelExpensePolicy.

Theexpensesareactualcostswithavalidprofessionalpurposeanddonotincludeanypersonalexpenses.

Requestor'ssignature Date

FormVersion:1/21/11