Travel Reimbursement – Request Form Travel Reimbursement Step 1 of 7 14% Preparer / Traveler InformationPreparer / Submitter(Required) I am submitting on my own behalf I am submitting on another's behalf Traveler | UW Status(Required)The relationship of the traveler to UW? UW Employee (staff, faculty, etc.) UW Student Non-UW Employee (guest, visitor, employment candidate, etc.) Preparer Name(Required) First Last Preparer | UW Email(Required) Name(Required)Name of individual you are preparing on behalf of. First Last Email(Required)Email of individual you are preparing on behalf of. Alternate ContactIn the event of your absence, who should be contacted? First Last Alternate Contact UW EmailAlternate contact's UW email address Affiliated UW Department/Unit(Required)Universal Payee Requirement(Required)Was the traveler/payee provided the UW Privacy Notice? Yes No Citizenship(Required)Is that traveler a U.S. Citizen or a Green Card holder? Yes No Unit(Required)- CHOOSE ONE -Academic Personnel (AP)Academic and Student Affairs (ASA)President (PRES)Provost (PROV)Faculty SenateHealth Sciences Services (HSS)Division of Campus Community Safety (DCCS)Attorney General's Office (AGO)AP Sub-Unit(Required)- CHOOSE ONE -AP: CoreAP: Ops, AHR, PIMAP: Ops ISOAP: Faculty AdvancementASA Sub-Unit(Required)- CHOOSE ONE -ASA: Academic Technologies (AT)ASA: AdmissionsASA: AdvancementASA: Center for Teaching and Learning (CTL)ASA: CoreASA: Financial AidASA: Information Services (ASA-IS)ASA: International Student ServicesASA: RegistrarASA: Strategic InitiativesDCCS Sub-Unit(Required)- CHOOSE ONE -DCCS: CoreDCCS: SafeCampusDCCS: Emergency ManagementDCCS: UWPDHSS Sub-Unit(Required)- CHOOSE ONE -HSS: Academic Services & Facilities (AS&F)HSS: CoreHSS: Interprofessional Education (IPE)PRES Sub-Unit(Required)- CHOOSE ONE -PRES: Board of Regents (BOR)PRES: CorePRES: Environmental Health & Safety (EH&S)PRES: Internal Audit (IA)PRES: OmbudPRES: Population HealthPRES: University Rules & PolicyPRES: UWINCOHome Station(Required)The location where the traveler lives. City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Duty Station(Required)The location where the traveler works. For example: for UW Seattle, the station is Seattle, WA. City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Non-UW | Email(Required)Provide a non-UW email address for the traveler. Enter Email Confirm Email Mailing Address(Required)The mailing address for the Non-UW traveler receiving this reimbursement. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country EO Assistance(Required)Did you consult with or receive assistance from an Executive Office Finance team member prior to filling out this form? No Yes Team Member NameWho assisted you?Trip InformationTrip | Pre-Travel Approval Form(Required)Do you have an authorized Pre-Travel Approval form on file with the Executive Office Finance team? No Yes Trip | Purpose(Required)- CHOOSE ONE -ConferenceEventOn-Campus MeetingOff-Campus MeetingTeam RetreatOtherTrip | Purpose | Other(Required)Trip | Conference, Event, Meeting | Name(Required)Please spell out acronyms, if applicableTrip | Conference, Event, Meeting | WebsiteProvide the website address that has information about conference/event/meeting registration fees, agenda, hotel, meals covered, etc. Trip | Conference | Documentation Upload(Required)Upload supporting documents related to conference registration, agenda, hotel, meals, etc. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Event | Start Date(Required)Ex: First day of conference, event, or meeting. MM slash DD slash YYYY Event | End Date(Required)Ex: Last day of conference, event, or meeting. MM slash DD slash YYYY Travel | Domestic or International(Required) Domestic International Travel | U.S. Destination(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Travel Approval FormA completed Travel Approval Form must be provided for any domestic destination outside of WA, OR, or ID.Travel Approval Form | Upload | Domestic(Required)Required for domestic travel to a destination outside WA, OR, or ID.Accepted file types: pdf, Max. file size: 15 MB.Travel | International Destination(Required) City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Travel | Date & Time Departure(Required)Provide the DATE and TIME of departureTravel | Date & Time Return(Required)Provide the DATE and TIME of departureTravel Approval FormA completed Travel Approval Form must be provided for any international destination.Travel Approval Form | Upload | International(Required)Required for international travel.Accepted file types: pdf, Max. file size: 15 MB.Personal Time(Required)Did this trip include personal time - outside the business purpose of the trip? No Yes - Before OR after official purpose of trip Yes - Before AND after official purpose of trip Personal Time | Dates & DestinationProvide details for one or both stretch(es) of personal time. Personal Time - Start Date Personal Time - End Date Location Actions Edit Delete There are no Personal Time Information. Add Personal Time Information Maximum number of personal time information reached. Personal Time | Dates & DestinationProvide details for one or both stretch(es) of personal time. Personal Time - Start Date Personal Time - End Date Location Actions Edit Delete There are no Personal Time Information. Add Personal Time Information Maximum number of personal time information reached. Trip Information | Additional InformationProvide any additional details about your trip or travel circumstances that may not be reflected in the previous questions and may help with processing your reimbursement request. MealsPer Diem | Advance(Required)Did you receive a per diem advance? No Yes Per Diem | Advance AmountPer Diem | Personal Meals(Required)Are you claiming meal per diem? No Yes Dates and MealsIdentify the meals for which you are seeking reimbursement. Event Date Meals Actions Edit Delete There are no Meals. Add Meal Maximum number of meals reached. Meals Paid for Others(Required)Did you pay for another's meal? No Yes Per Diem | Meals for Others | Dates and MealsIdentify the meals for others that you paid for. Meal Date Meal(s) Meal Total for the Day Actions Edit Delete There are no Meal Details. Add Meal Details Maximum number of meal details reached. Per Diem | Meals for Others | Receipt Upload(Required)Itemized receipts are required when paying for meals on another's behalf. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Per Diem | Meals | Additional InformationProvide any additional details about your food per diem that may not be reflected in the previous questions and may help with processing your reimbursement request. Per Diem | LodgingPer Diem | Lodging(Required)Did this trip require lodging? No Yes Per Diem | Lodging DetailsThe number of nights must correspond with official event date(s) and/or travel dates. Lodging used while on Personal Time cannot be included. # of Nights Total Amount Per Diem Overage Actions Edit Delete There are no Lodging Details. Add Lodging Details Maximum number of lodging details reached. Per Diem | Lodging | Folio or Receipt Upload(Required)Upload the hotel folio (bill) or itemized final receipt. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Per Diem | Lodging | Additional InformationProvide any additional details about your lodging per diem that may not be reflected in the previous questions and may help with processing your reimbursement request. Itemized Travel ExpensesMiscellaneous Travel Expenses ExceptionA receipt is not required to be uploaded for certain miscellaneous travel expenses less than $75. More info at UW Finance Receipts Policies.Registration | Fee(Required) No Yes Registration | Total(Required)Registration | Receipt Upload(Required)Receipt required for registration amounts over $75. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Airfare | Expenses(Required) No Yes Airfare | Total(Required)Airfare | Receipt UploadReceipts required for airfare amounts over $75. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Comparison Airfare with Personal TimeDocumentation is required that illustrates the difference in airfare price to accommodate personal time travel dates instead of official business travel dates. Be prepared to upload this documentation with this reimbursement request.More info at UW Finance Travel Planning - Personal Time.Comparison Airfare | Documentation Upload(Required)Required when personal time is taken pre- or post-business event dates. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Baggage | Fees(Required) No Yes Number of Bags(Required)Baggage | Total(Required)Baggage | Receipt Upload(Required)Required when baggage fees total more than $75. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Car Service | Expenses(Required)Taxi, Shuttle, Uber, Lyft, Town Car, Limo No Yes Car Service | Total(Required)Car Service | Receipt Upload(Required)Required when any car service is utilized. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Rental Car | Expenses(Required) No Yes Rental Car | Type(Required) Rental car was a sedan Rental car was NOT a sedan Rental Car | Justification(Required)Provide justification for not renting a sedan.Rental Car | Total(Required)More information about the Rental Car Documentation requirement on the UW Finance website.Rental Car | Receipt Upload(Required)Please upload car rental agreement and corresponding receipts. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Parking | Expenses(Required) No Yes Parking | Total(Required)Parking | Receipt Upload(Required)Receipt required if over $75. Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Personal Vehicle | Mileage(Required)Are you claiming mileage for using a personal vehicle? No Yes Personal Vehicle | Mileage Total(Required)Mileage DocumentationUpload Google Maps mileage confirmation. More info at UW Finance Mileage Policy.Personal Vehicle | Mileage Verification(Required) Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Other Expenses(Required) No Yes Other Expenses | Items & Costs Row ID Purchase Date Item Purchased Item Cost Actions Edit Delete There are no Miscellaneous Items. Add Miscellaneous Item Maximum number of miscellaneous items reached. Other Expenses | Receipt Upload Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 15 MB. Perjury Statement - Missing ReceiptsMissing receipts(Required)Are you missing any receipts for individual purchases over $75? No Yes Perjury StatementFor each missing receipt for purchases over $75, please complete and upload a Perjury Statement (PDF) [UWNetID required] as an attestation for claiming reimbursement for a UW business expense.Perjury Statement(s) UploadOne perjury statement required for each missing receipt. Drop files here or Select files Accepted file types: pdf, Max. file size: 15 MB. Travel Reimbursement SubmissionAdditional InformationUpload any additional documentation that would be helpful to EO Fin Team when reviewing this request.Documentation UploadUpload any additional documentation that would be helpful to the EO Fin Team when reviewing this request. Drop files here or Select files Accepted file types: pdf, doc, docx, xls, xlsx, jpg, jpeg, png, Max. file size: 15 MB. Acknowledgement/Attestation(Required) I agree that, to the best of my knowledge, the information that has been provided in this form is true and accurate.Submitter Signature(Required)