Travel Request

Name (as it appears on driver’s license):

Department:

E-mail:

Title:

Home Address:

City/State/Zip:

Business Purpose of Travel:

Destination City & State:

Mode of Transportation:
Personal Vehicle State Vehicle Air

If traveling by state vehicle, please enter the vehicle number:

Departure Date: (Valid format: mm/dd/yyyy)
Departure Time: a.m. p.m.

Return Date: (Valid format: mm/dd/yyyy)
Return Time: a.m. p.m.

Conference Registration arranged by:
Traveler Centralized Travel Coordinator

Note: Lodging arranged by traveler see: http://www2.kumc.edu/finance/pdf/MileageExpLimits.pdf for lodging reimbursement limitations.

Hotel Name:

Rate:

Designated Conference site: Yes No

Speedtype/Account/:

Supervisors Name:

I have obtained my Supervisors approval: Yes No

Please make an appointment with Cindy Roth within one week of on-line submission to bring AFS all supporting documentation, e.g. conference brochure, registration form, and lodging information.

When sending this form, you are issuing an electronic signature which holds you accountable as though it were a physical signature.

For Questions, call AFS 3-2600