H&SSBUSINESSEXPENSEREIMBURSEMENTREQUEST
INSTRUCTIONS
1.Completeallrelevantinformation.
2.Submittherequesttothedepartmentpreparerwithin30days ofincurringtheexpense.
3.Alloriginal,itemizedreceiptsmustbeattachedtothisrequest.
NAME:____________________________________________________________________________
CHARGETO:_______________________________________________________
BUSINESSMEALS
H&SSPolicyStatement: Businessmealsshouldnotexceed
75perperson,includingtaxandtip,for2‐5guests.
Forgroups>5thetotalcostshouldnotexceed$375.Ifyourdepartmentheadapprovedanexceptiontothislimit
priortothemeal,pleaseattachthatcorrespondence.Otherwise,thedepartmentheadmustapprovebysigningbelow.
DepartmentHead_____________________________________________________________
PURPOSE(Pleasecirclecategoryanddescribebelow.)
Forgroupsof5orless,providenamesandaffiliationofattendees.For6+,providetheheadcountandaffiliations
GuestSpeakerRecruitmentSpecialEventProfessionalCollaboration
Listexpensesbelowandattachitemizedchecksalongw
creditcardreceipts.Identifyalcoholonthecheck.
DATE DESCRIPTION AMOUNT
GENERALEXPENSES
Listexpensesbelow,includingpurposeofitems,andattachitemizedreceipts.
DATE DESCRIPTIONANDPURPOSE AMOUNT
REQUESTOR'SSIGNATURE
Tothebestofmyknowledge,thisrequestcomplieswiththeUniversityBusinessandTravelExpensePolicy.
Theexpensesareactualcostswithavalidprofessionalpurposeanddonotincludeanypersonalexpenses.
Requestor'ssignature Date
FormVersion:1/21/11