Form – Research and Creative Activity Expense Report Request

Please use this form to submit all receipts for reimbursement.

RCA Reimbursement Request

Name(Required)

First Last

Email(Required)

What Department is the funding for this coming from?(Required)

Please provide the fund source for this reimbursement(Required)

(e.g. 4010.70610.1001004.2000001010)

Is this reimbursement for travel-related expenses?(Required)

Yes

Please provide a business purpose for this request

“Who, what, where, when, why” Example: Dry ice for storing samples for EPSCoR Research”

Travel Reimbursement

Please provide the Travel Authorization number for your trip

Are you requesting reimbursement for Per Diem?

Yes

How would you like to be reimbursed for Per Diem?

I will provide receipts for meals

Please reimburse me at the Per Diem Rate

Per Diem – Provided Meals

If meals were provided during your travel please indicate which meals and the days which they were provided below.

The following information is required to determine Per Diem reimbursement allowability. If you are attaching a flight itinerary/receipt you do not have to complete this section

Travel Departure Date

What day did you depart for travel?

Departure Time

What time did you depart for travel?

AM/PM

Travel Return Date

What day did you return for travel?

Return Time

What time did you return from travel?

AM/PM

Comments/Notes

Is there anything you would like us to know about this request?

Upload Receipts

Please upload your receipts here. For travel reimbursements please upload associated P-Card receipts if applicable.

Receipt Upload

Drop files here or

Accepted file types: pdf, xls, xlsx, doc, docx, Max. file size: 10 MB.

Form – Research and Creative Activity Expense Report Request

RCA Reimbursement Request

Travel Reimbursement

Upload Receipts

College of Arts and Sciences