Travel Reimbursement Form

TRAVEL REIMBURSEMENT FORM

TRAVEL REIMBURSEMENT OF UP TO $500 ONLY. REIMBURSEMENT WILL NOT EXCEED $500. (Receipts Required: Total Miles Driven OR original receipts, or copy of etickets)

Mail my reimbursement check to: (street address)

(city, state, and zip code)

Arrival: I am requesting reimbursement for travel from to Chapel Hill. (city & state)

Departure: I am requesting reimbursement for travel from Chapel Hill to

(city & state)

Mode of Transportation: Those arriving/departing via plane, bus, or train MUST submit your receipt or NO reimbursement will be made.

Plane (airline ticket or eticket attached) Bus (bus ticket attached) Train (train ticket attached) Car ( number of miles roundtrip- attach mapquest mileage) TAXI Receipt(s)- if you travel via taxi from airport to Chapel Hill, submit a copy with this form. If you travel via taxi from Chapel Hill to the airport upon your departure, fax your receipt (919-843-2554) once you have reached your destination.

Return completed form & backup documentation to Darla Wohlfarth before departure: Kenan Labs, Suite A207 UNC Campus

For Office Use Only Total Amount Requested (up to $500): $ Total Amount Reimbursed: K #