EXPENSE REIMBURSEMENT First Name Last Name SS#/Employee ID# Received On: Activity Dates Title of Activity LIST ALL THE EXPENSES IN THE CATEGORIES LISTED BELOW – PLEASE PRINT LEGIBLY *Date **Description *Registration *Transportation *Lodging *Meals *Misc Total Sub Total ORIGINAL RECEIPTS AND APPROPRIATE DOCUMENTATION MUST BE ATTACHED. Keep copies for your record TOTAL VEHICLE INFORMATION MAKE/MODEL CAR: BEGINNING MILEAGE: LICENSE NUMBER: ENDING MILEAGE: ODOMETER READING: MILES DRIVEN: I have read the Official District Travel Memo printed on the back side of this form and hereby certify that expenditures claimed are true and correct, incurred according to the law and City College regulations, and in connection with official business of City College of San Francisco. ________________________________________________ ______________________ ____________________ Applicant’s Signature Telephone Date OFFICE USE ONLY __________________________________________ $_________________ ___________________ Payment Authorization Signature Refund Amount Date College Appropriation Number Funding Source FUND ORGN ACCT PROG ACTV AMOUNT POSTED BY Grant#: ____________ PD#: _______________ MR: 5/29/2007 Official District Travel Memo 1. NOTE: All documents must be submitted within TEN (10) business days after the activity ends, or you may not be reimbursed. ORIGINAL paid receipts are required for business expenses, meals, hotel, public carrier transportation and other miscellaneous expenses. 2. REGISTRATION: Verification of Payment and Attendance: Canceled Checks and Credit Card Receipts are NOT valid unless supplemented by a copy of the Brochure and Registration material showing fees. If paid by check, you must attach a copy of the front and back of the cashed check. If paid by Credit Card, you must attach a copy of the Credit Card Statement showing payment of the activity. Handwritten receipts, receipts printed without the logo, and receipts that are not printed on the letterhead of the organization, must be supplemented by a copy of the cashed check or bank statement and attached to the receipt. Also required is proof of completion of activity: copy of certificate, grades, etc. Tuition / Class / Course: For school tuition, receipt of payment with a logo from the institution must be supplemented by a grade report of “C – “ or higher. If grades are not given for the course, attach a letter from the Instructor verifying the completion of the course and indicating a grade (if given), or whether or not you have passed the course. If a certificate was received, a copy must be attached. 3. TRANSPORTATION: Airfare is reimbursed at the economy / coach or lesser fare rate. You must attach your passenger ticket to the Expense Report. If a personal automobile is used instead of public carrier, give the make, model, year license number of automobile used, total mileage, beginning and ending odometer reading, and the starting and ending point of travel. In such cases the claim cannot exceed the equivalent of such trip, by the most efficient, direct, and economical mode of transportation required by the occasion. If two or more officers or employees of the District are authorized to attend the same activity within the State, and travel in the same automobile on the same trip, mileage will be allowed provided such mileage claim does the aggregate fares for the most efficient, direct and economical mode of public transportation required by the occasion. Mileage is to be claimed by the driver only. In this case, advise the names of persons traveling with you. If you are the passenger, please the state name of the driver. Receipts are required for bridge toll and off-street parking (parking lot and / or garages). 4. LODGING: Reimbursement for accommodations will only be made for the days the activity is scheduled. Payments for the use of the hotel’s gym facilities, purchase of cable movies, laundry / dry cleaning, bellhop, and valet services, etc. will not be reimbursed. If traveling out of state, contact the CCSF Accounts Payable Department for the Official Lodging and Per Diem Manual for the authorized reimbursement amount(s). 5. MEALS: This section is used to record meals and must be supported by receipts. Tips cannot be reimbursed, since to do so would constitute a gift of public funds. Alcoholic beverages will not be reimbursed. Explanation of any meal amounts over normal should be noted on the form. When travel does not require lodging, meals will be reimbursed only if activity was attended prior to and directly after the meal and it is so stated on the Expense Report. If meals are included with the cost of the activity, you cannot claim additional meals reimbursement. 6. AUTHORIZATION: Your Supervisor’s, Department Chair’s, Vice Chancellor, and/or Chancellor’s signature MUST be present for reimbursement. MR: 5/29/2007