Travel Reimbursement Request Form

Please contact Rhonda at 645-6690 or rhondapa@buffalo.edu if you have additional questions or concerns.

Please leave blank

Personal Information

Full Name

(Required)

Address

(Required)

Person Number

(Required)

Phone Number

UB Account to Charge (Ask your advisor)

(Required)

Are you

(Required)

State Employee

RF Employee

Unpaid Graduate Student

Unpaid Undergraduate Student

How are you normally paid?

(Required)

Direct Deposit

Paper Check

Citizenship

(Required)

Faculty Advisor

(Required)

Trip Information

Conference Program Name

(Required)

e.g 2018 Annual AIChE, 2016 Regional AIChE

Destination

(Required)

e.g. New York City, NY

Departure Date and Time

(Required)

e.g. September 20, 2018 at 8:00AM

Return Date and Time

(Required)

e.g. December 3, 2019 at 3:20PM

Expenses to Be Reimbursed

For the sections below, please fill in the space that applicable to you. Please also note that a PDF version of your original receipts for every item requested in each category should be scan and upload along with the form. If you encounter problems with this step, please contact Rhonda Pangrazio at Furnas 308 or at rhondapa@buffalo.edu.

Conference Program Registration Fee Amount

Please Upload Your Conference Program Registration Receipt

Please Upload Conference Flyer and/or Schedule

Hotel Name*

e.g. Hilton

Lodging Amount

e.g. $201.35

Please Upload Receipt, Folio and Credit Card Statement for Lodging Charges Here

Flight and Flight Number

e.g. Delta, DE205

Flight Cost

Please Upload Flight Information and Receipt Here (Must show times and fare class)

Total Taxi or Uber/Lyft Fee Amount

Please Upload All Taxi Receipts Here

Total Meals Amount, (note if per diem)

Please Upload All Meal Receipts Here (not required if requesting per diem)

Total Parking Fee Amount

e.g. $23.65

Please Upload All of Parking Receipts Here

Total Tolls Fee Amount

Car Rental

e.g. Hertz

Car Rental Amount

Please Upload Car Rental Information and Receipt Here

Additional Expenses or Information Description

Additional Expenses Amount

Please Upload All of Additional Expenses Receipts Here

Total Reimbursement Request Amount

(Required)

*For meal reimbursement, a hotel bill with a $0 balance is required. Even if you didn’t pay for it. For rental cars, a written statement of why you rented instead of taking a cab is required. If expenses were shared, please turn in reimbursement requests together. Reimbursements will not be made until all persons have requested reimbursement. - please note which expenses were shared.

State travel must be booked through CTA-see a secretary for details.

Travel Reimbursement Request Form

Personal Information

Trip Information

Expenses to Be Reimbursed

Admissions

Information For

Connect With Us