Travel Expenses and Reimbursement Form

If you need to be reimbursed for expenses related to a CLPP program, the reimbursement must be processed through the Hampshire College Business Office because CLPP is a program of Hampshire College. When you are submitting for reimbursement, the Hampshire College Business Office has specific guidelines about what types of receipts and charges are acceptable. Please see the Policy on Travel and Reimbursement for further details.

Once you submit this form, we will send you a Request for Payment (RFP) and a W-9 form with a return envelope. Please sign and return these promptly, and include all of your original itemized receipts.

Personal Information

First and last name: *

Legal name:

Legal name is the name that the reimbursement check will be made out to. If your organization should be reimbursed, please enter the organization name here.

Legal Address: *

Legal address should match what you put on your W-9.

Mailing Address:

If your reimbursement check should be mailed to an address other than the legal address, please enter it here.

Email address: *

Phone number: *

Are you a U.S. citizen?: *

yes

Event Information

Event type: *

CLPP Conference

NLNI Meeting

RRASC Internship

other

Please check all that apply.

If you selected other, please describe:

Travel start date: *

Travel end date: *

Airfare

Total amount: $

Do you have the original receipts?:

Do you have the boarding passes?:

Ground transportation

Train, bus, cabs, and shuttles

Date:

Total amount: $

Do you have the original receipts?:

Mileage

The reimbursement rate is $0.51 per mile.

Total number of miles:

License Plate: #

We cannot reimburse you for mileage without the license plate #.

Parking

Total amount: $

Do you have the original receipts?:

Meals while traveling

Meal 1

Date of meal:

Meal:

Number of participants:

Total amount: $

Meal 2

Date of meal:

Meal:

Number of participants:

Total amount: $

Meal 3

Date of meal:

Meal:

Number of participants:

Total amount: $

Other expenses

Date:

Description:

Amount: $

Original receipts?:

yes

Other expenses

Date:

Description:

Amount: $

Original receipts?:

yes