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KSR Travel Application Form
KSR Travel Application Form
Date
Date
*
/
MM
/
DD
YYYY
Name
Name
*
First
Last
E-Number
*
Email
*
Check Only One
*
Check Only One
Employee Only Attending
Employee Presenter
GA/Student Employee
GA/Student Academic Purpose
Purpose of Travel
*
Destination
*
Dates of Travel
*
Personal Vehicle Estimated Cost
- $0.40/mile (fleet vehicle available but denied OR not pursued)
- $0.62.5/mile (fleet vehicle unavailable)
*
Personal Vehicle Estimated Cost
- $0.40/mile (fleet vehicle available but denied OR not pursued)
- $0.62.5/mile (fleet vehicle unavailable)
N/A
Cost
Cost
University Fleet Vehicle Estimated Cost
- Sedan: $25/day OR $0.40/mile
$12 for 4 hours or less OR $0.40/mile
- Mini-Van (7 passengers): $35/day OR $0.46/mile
$16 for 4 hours or less OR $0.46/mile
- Full Size Van (11 passengers): $61/day OR $0.46/mile
$30 for 4 hours or less OR $0.58/mile
*
University Fleet Vehicle Estimated Cost
- Sedan: $25/day OR $0.40/mile
$12 for 4 hours or less OR $0.40/mile
- Mini-Van (7 passengers): $35/day OR $0.46/mile
$16 for 4 hours or less OR $0.46/mile
- Full Size Van (11 passengers): $61/day OR $0.46/mile
$30 for 4 hours or less OR $0.58/mile
N/A
Cost
Cost
Per Diem (Meals)
- $28/day within Illinois
- $32/day outside of Illinois
*
Lodging Expense per Night
*
Registration Expense
*
Miscellaneous Expense (tolls, parking, etc.)
*
Provide Details of Miscellaneous Expenses
Funding Source
*
Funding Source
Department Funds
Out of Pocket