Clear Form
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