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VALENCIA COMMUNITY COLLEGE

FA-33 Rev. 03-09

AUTHORIZATION FOR TRAVEL OR ABSENCE FROM CAMPUS NAME (print or type) ___________________________________________VID # V0____________________MC_________ PLACE TO BE VISITED ________________________________________________________________________________ DATE AND TIME: Departure ___________________________

Return ______________________________________

TIME/DATE CONFERENCE OR CONVENTION Begins ___________________ Ends __________________________ REASON FOR TRIP ____________________________________________________________________________________ IF TRAVEL IS TO BE REIMBURSED FROM SOURCES OTHER THAN VALENCIA FUNDS, INDICATE SOURCE: ______________________________________________________________________________________________________ ESTIMATED FUNDS REQUESTED: $0.00 I. PER DIEM:_________ Days @ $80.00 per day…………....................................................................... $______________

II. A. SINGLE ROOM RATE _________

$0.00 $_______________

Nights @ $___________

TRAVELER TO PAY

P-CARD

CHECK REQUEST

B. MEALS: _________Breakfast ($6) __________Lunch ($11) ____________Dinner ($19)… III. TRANSPORTATION:

TRAVELER TO PAY

P-CARD

CHECK REQUEST

TRAVEL BY:  Airplane  Bus/Van  Car Estimated Miles (D.O.T) ______@ $.445per mile If car, driver & passengers: ________________________________________________________ IV. REGISTRATION:

TRAVELER TO PAY

P-CARD

CHECK REQUEST

V. MISC. (List all other expenses): _____________________________________________ (Receipts required for any item over $5.00 e.g. taxi, car rental etc.) VI.

$0.00 $_______________

LESS: Meals included in registration fees: ____B ($6) _____L ($11) ____D ($19)

$0.00 $_______________

$0.00 $________________ $0.00 $________________ $0.00 (_______________)

$0.00

TOTAL ESTIMATED COSTS* $ _______________

Charge to : Index__________ Acct__________ Amount__________Bud. Mgr. Sign.________________Print Name_____________________ Index__________ Acct__________ Amount__________Bud. Mgr. Sign.________________Print Name_____________________ Index__________ Acct__________ Amount__________Bud. Mgr. Sign.________________Print Name_____________________

______________________________________________ Signature of Traveler**

__________ Date

______________________________________________ Approved by Supervisor

__________ Date

ADVANCE REQUESTED $_____________________

*Payment will be made upon submission of a Per Diem Voucher following the trip with all receipts attached. **Traveler’s signature indicates that he/she is aware of the travel policies of Valencia Community College and understands that this authorization is granted subject to conformity with said policies. Submit this form to Accounts Payable DTC-3


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