WHITEHEAD INSTITUTE

TRAVEL AUTHORIZATION FORM (Example)

DATE: 04/08/02
TA Number:
TRAVELER AND DEPARTMENT/LAB INFORMATION
Traveler's Name  Mary Jo Dept/Lab Name
 Operations
Traveler's Title Dir Operations Dept/Lab Contact Person
same as traveler
WI Phone Number:
8-4444
TRIP INFORMATION
Purpose and Destination : Lawson User conference, San antonio Texas
Date(s) of Trip: REQUIRED ARRANGEMENTS:  ESTIMATED COSTS
From:  4/20/02 
 Transportation  
500.00
 Lodging and Meals 
1000.00
To:  4/25/02 
 Registration Fee 
995.00
 OTHER (explain):_______________   
 Foreign Travel: Yes___ No __  TOTAL  $2,495.00
REQUEST FOR CASH ADVANCE AND/OR PREPAYMENT OF TRAVEL EXPENSES
** IMPORTANT: All cash advances and expenses paid by for the institute must be settled within 10 days of the completion (or cancellation) of the trip
Air ticket purchased with the Institute Charge Account Yes___ No__X_   
Complete a Check Request Form and provide an explanation if requesting any of the following:
 Cash Advance (payable to Traveler): _______________
 Registration Fee: Lawson User conference
 Other (payable to other than Traveler): ________________________
POLICY EXCEPTIONS AND TRAVEL CIRCUMSTANCES THAT REQUIRE PRIOR APPROVAL
Provide back up documentation for any of the travel requirements selected below
 Use of other than Economy/Coach airfare    Explanation:
 Extended Stay (or personal time will be taken)    
 Foreign Airline   
 Other:_______________   
FUNDING INFORMATION
ACTIVITY NUMBER
 ESTIMATED AMOUNT       
 01-0010-0101 Grant/Acctg
  2,495.00
  
  
     
THIRD PARTY: ___________________________
 
    TOTAL ESTIMATED 
$2,495.00
REQUIRED SIGNATURES/APPROVALS
Traveler's Signature (1)      DATE  
Dept./Lab Approval (2)     DATE  
Grants/Business Office Approval (3)   DATE  
(1) Indicates that information provided is correct, proper documentation is included, and that traveler agrees to settle any advance received after the completion of the trip.
(2) Indicates that travel has been authorized, funding is available, and exceptions to policy have been approved        

Last Updated on 5/21/02
By User