MATHEMATICS & STATISTICS DEPARTMENT

TRAVEL REQUEST

PLEASE SUBMIT 3 WEEKS PRIOR TO DEPARTURE

***Will not be submitted to Chair for Approval until the form is complete – every blank even if you are not requesting funds!!!***

Employee Name:_____________________________________ ASU ID#:_____________________

Account Name:______________________________________ Account No.:___________________

Inclusive Dates: From:_______________To:______________ Destination:____________________

Classes/Obligations assumed by:______________________________________________________

Class:____________Place:___________Time:________Date:________Covered by:_____________

Class:____________Place:___________Time:________Date:________Covered by:_____________

Class:____________Place:___________Time:________Date:________Covered by:_____________

Class:____________Place:___________Time:________Date:________Covered by:_____________

Convention Meeting Dates (if any): From:________________To:________________________

Transportation funded by (if other than ASU funds):____________________________________

Personal Vehicle:__________(Auto mileage cannot exceed air coach fare):________Mi@______Mi $_____________

Plane Fare___________________________ $_____________

Taxi___________Bus__________Limo___________Train___________ $_____________

Per Diem (Meals and incidental expenses)_________days@_________$/per day $_____________

Lodging:_________night@_________$/night $_____________

Registration Fees $_________Parking $___________Rental Car $_________ $_____________

(Rented Auto Justification required below)

TOTAL ESTIMATED COST $_____________

AIRLINE TICKETS: Was on campus agency used? (Circle one) yes no

If yes, how was agency paid? By credit card/cash Direct by ASU to Agency

PURPOSE/JUSTIFICATION: (How ASU/STATE project will benefit). If more than one person is attending the conference/meeting, indicate so and justify. If car will be rented show justification. Attach additional sheet(s) if necessary.

Cash Advance requested (Circle one): yes no

Air Fare(100%)________________ Remainder (75%)______________

Approved: Yes__________ No_________ ____________________________________

Dieter Armbruster, Chair