Travel and Per Diem Request Form - Nome Public Schools

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Nome Public Schools
  T ravel and Per Diem Request
Legal   N ame
o f   I ndividual   T raveling:____________________________________________
  ( first,   m iddle,   l ast)  
Contact   P hone   ( cell)
___Male
__Female
:_________________
Date   o f   B irth:_____________________
Purpose   f or   T ravel
:______________________________________________________________________________
            ( a$ach   n ecessary   i nforma0on,   e .g.,   a genda)
Dates   o f   e vent
D esBnaBon
:__________________________________
   
:______________________________
Desired   D eparture   D ate   &   T ime
:___________________
    R eturn   D ate   &   T ime:_________________________
Funding   S ource(code)
Total   E s.mated   C ost   o f   T rip:   $ ______________
:_________________________________
(to   b e   c ompleted   b y   t raveler)
Airfare PO#
Lodging PO#
Registration PO#
Per Diem PO#
Other PO#
_____________
_______________
_______________
_______________
__________
Airfare:
Lodging:
Vendor   N ame:____________________________
Vendor   N ame:____________________________
Mileage   # :   _ ______________________________
Dates   o f   S tay:_____________________________
Preferred   S eaBng:   _ ________________________
Est.Cost/Night:$___________   # Nights:_________
EsBmated   C ost:$   _ _________________________
ReservaBon#:_____________________________
Other Costs:
ConfirmaBon   C ode:________________________
Vendor   N ame:____________________________
Registration:
Please   s pecify:____________________________
Vendor   N ame:____________________________
________________________________________
EsBmated   C ost:$__________________________
EsBmated   C ost:$__________________________
RegistraBon#:   _ ___________________________
ReservaBon#:   _ ___________________________
To   C alculate   P er   D iem,   F ill   i n   t he   b lanks   w ith   r equired   p rice.   M eals   i ncluded   w ith   c onference   s hould   b e   m arked   w ith   " X"
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Date
Breakfast $15
Lunch $20
Dinner $25
If an airport shuttle is not complimentary, add $20 taxi/shuttle fee
Total Per Diem
$
*Actual   C ost   o f   T rip:   $ _______________
Requested   b y:________________________________________________________________________________
Supervisor/Budget   A dministrator   a pproval:_________________________________________________________
Superintendent   a pproval:_______________________________________________________________________
Business   M anager   a pproval:_____________________________________________________________________
Nome Public Schools
  T ravel and Per Diem Request
Legal   N ame
o f   I ndividual   T raveling:____________________________________________
  ( first,   m iddle,   l ast)  
Contact   P hone   ( cell)
___Male
__Female
:_________________
Date   o f   B irth:_____________________
Purpose   f or   T ravel
:______________________________________________________________________________
            ( a$ach   n ecessary   i nforma0on,   e .g.,   a genda)
Dates   o f   e vent
D esBnaBon
:__________________________________
   
:______________________________
Desired   D eparture   D ate   &   T ime
:___________________
    R eturn   D ate   &   T ime:_________________________
Funding   S ource(code)
Total   E s.mated   C ost   o f   T rip:   $ ______________
:_________________________________
(to   b e   c ompleted   b y   t raveler)
Airfare PO#
Lodging PO#
Registration PO#
Per Diem PO#
Other PO#
_____________
_______________
_______________
_______________
__________
Airfare:
Lodging:
Vendor   N ame:____________________________
Vendor   N ame:____________________________
Mileage   # :   _ ______________________________
Dates   o f   S tay:_____________________________
Preferred   S eaBng:   _ ________________________
Est.Cost/Night:$___________   # Nights:_________
EsBmated   C ost:$   _ _________________________
ReservaBon#:_____________________________
Other Costs:
ConfirmaBon   C ode:________________________
Vendor   N ame:____________________________
Registration:
Please   s pecify:____________________________
Vendor   N ame:____________________________
________________________________________
EsBmated   C ost:$__________________________
EsBmated   C ost:$__________________________
RegistraBon#:   _ ___________________________
ReservaBon#:   _ ___________________________
To   C alculate   P er   D iem,   F ill   i n   t he   b lanks   w ith   r equired   p rice.   M eals   i ncluded   w ith   c onference   s hould   b e   m arked   w ith   " X"
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Date
Breakfast $15
Lunch $20
Dinner $25
If an airport shuttle is not complimentary, add $20 taxi/shuttle fee
Total Per Diem
$
*Actual   C ost   o f   T rip:   $ _______________
Requested   b y:________________________________________________________________________________
Supervisor/Budget   A dministrator   a pproval:_________________________________________________________
Superintendent   a pproval:_______________________________________________________________________
Business   M anager   a pproval:_____________________________________________________________________

Download Travel and Per Diem Request Form - Nome Public Schools

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