Professional Meeting Request

DATE NAME
TITLE OF MEETING/CONFERENCE
(Attach a copy of the meeting/conference announcement)
ORGANIZATION SPONSORING EVENT
REASON FOR ATTENDING
LOCATION OF MEETING/CONFERENCE
MEETING IS (Check one): LOCAL STATE  OTHER
DATE(S) OF MEETING/CONFERENCE: FROM THROUGH
ARE CLASS DAYS INVOLVED? (If yes, state how you intend to cover for the missed class time.)

YES  NO  _____________________________________________________________
  ESTIMATED EXPENSES                      ACTUAL EXPENSES (To be completed by Administration)
REGISTRATION $ $
LODGING $ $
MEALS $ $
TRANSPORTATION $ $
(If transportation is by private automobile, multiply mileage by .51. This should not exceed the lowest airfare available. If using the college vehicle, the department will be charged for the mileage cost and this should be included.)
OTHER (Specify)__________________ $ $
OTHER ______________________ $ $
OTHER ______________________ $ $
TOTAL $ $

(If you need to have registration fees paid directly by the College, identify this requirement.)

_____________________________________ ___________________________________________
ACCOUNT NUMBER TO BE CHARGED SIGNATURE - DATE
_____________________________________ ___________________________________________
DEPARTMENT HEAD - DATE VICE PRESIDENT, ACADEMIC AFFAIRS - DATE

Expenses will be reimbursed to a maximum amount of $ ___________________________. Expenses to be reimbursed will be paid upon completion of this form prior to the meeting. After return from the meeting complete the blue form for reimbursement. Attach copies of all receipts to the blue form to substantiate expenses. REVISED 01/11. After completion of this document, print and give to your Administrator.