Reimbursement Request Form

Reimbursement requests for expenses older than sixty (60) calendar days will be taxable to the traveler. Reimbursement requests for expenses older than one hundred twenty (120) days will be denied, see University Policy 6290 (Accountable Plan).

Name:(Required)

First Last

Employee ID:(Required)

Email(Required)

Reason for reimbursement(Required)

Travel

Non-travel

TA Number (5-digits)

Travel Location:(Required)

City, State/Country

Select expenses for which you are requesting reimbursement.(Required)

Provide exact dollar amounts for each expense selected. You will be prompted to upload itemized receipts for reimbursable expenses. (See below.)

Airfare

Lodging

Registration

Transportation-Personal Vehicle

Transportation-Public

Transportation-Rental Car

Miscellaneous

Per Diem

Airfare(Required)

Lodging(Required)

Registration/Membership(Required)

Per Diem(Required)

*Business meals will not be reimbursed if they have been paid for by other means such as per diem or meals included in prepaid conference fees.

Transportation-Personal Car – Mileage Log: https://www.boisestate.edu/vpfa-travel/tools-resources/(Required)

Transportation-Public(Required)

Transportation-Rental Car(Required)

Miscellaneous(Required)

Non-travel related expense(Required)

Total Reimbursement Requesting

Please add additional information if necessary.

(Optional)

Receipts.

You have the option to upload all receipts as one file or each receipt individually. These are not required fields as each submission will be different.

All receipts as one upload.

Max. file size: 10 MB.

Receipt #1

Max. file size: 10 MB.

Receipt #2

Max. file size: 10 MB.

Receipt #3

Max. file size: 10 MB.

Receipt #4

Max. file size: 10 MB.

Receipt #5

Max. file size: 10 MB.

Receipt #6

Max. file size: 10 MB.

Receipt #7

Max. file size: 10 MB.

The following information is necessary for the administrator to calculate per diem.

Travel Departure Date:(Required)

YYYY

Time of Departure(Required)

AM/PM

Travel Return Date:(Required)

YYYY

Time of Return(Required)

AM/PM

Reimbursement Request Form

Receipts.

The following information is necessary for the administrator to calculate per diem.

Department of History