* Denotes required field.

*Select:	Employee Student/Non-Employee	*Applicant:
*ID# (Last 4 Only):		*Employing Dept/Unit:
*Dept Contact:		*Ext:

TRAVEL DATA

*Purpose:
*Destination:
*Individual responsible for day-to-day operations in your absence:
*Dates of Travel: (From)		(To)
*Work Phone #:		Travel Phone #:
*Email:

ESTIMATED COSTS (Do not include prepaid expenses in estimated costs. If any item is prepaid, submit on Prepaid Form.)

1. Transportation Cost:	Air	Personal Car	Other	Total	$
2. Automobile Rental:					$
3. Registration Fees:					$
4. Hotel and Meals:	Hotel	Meals		Total	$
5. Other: (Taxi, Parking, Phone)					$
		Total Estimated Cost (To Be Paid As Outlined Below)			$

REIMBURSABLE COSTS (*At least one is required.)
The following account numbers are to be used for reimbursement, if expenses are shared by different budget units, list each number and the amount each will pay:

1.	$	Limit reimbursement charged to this account Pay actual expenses if trip cost exceeds this estimate
2.	$	Limit reimbursement charged to this account Pay actual expenses if trip cost exceeds this estimate
3.	$	Limit reimbursement charged to this account Pay actual expenses if trip cost exceeds this estimate
4.	$	Limit reimbursement charged to this account Pay actual expenses if trip cost exceeds this estimate
	Total Reimbursable Cost $ (Should Equal Total Estimated Cost Unless Reimbursement Is Limited)

*E-mail address of approver of reimbursable costs - Line 1 :
*E-mail address of approver of reimbursable costs - Line 2 :
*E-mail address of approver of reimbursable costs - Line 3 :
*E-mail address of approver of reimbursable costs - Line 4 :
*I attest that the above travel plans will comply with USG Travel Regulations:	Select Yes No
*Have you viewed the motor vehicle use video:	Select Yes No
*Have you completed the drivers acknowledgement form:	Select Yes No
*I am aware that failure to submit flight details will result in non-reimbursement for airfare:	Select Yes No

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