Concur Request Form for CAPS Travelers Traveler’s Name: ___________________________________________ Request #: (office use only) __________________ Budget/ Project #: ____________________________ Travel Start Date: ______________________________ PI’s Approval Signature________________________ Travel End Date: ______________________________ Destination City, Country: _____________________________________________________________________________ Personal/ non-business travel dates (if any): ______________________________________________________________ Name of event /meeting /etc.: _________________________________________________________________________ Purpose of Travel (select one): Choose an item. Benefit to University (select one): Choose an item. $ ________ $ ________ FSU TRAVEL CARD CHARGES Airfare: *Lodging: ** Avis compact-sized auto rental: $ ________ Conference registration fee: $ ________ Conference link: TOTAL on T-card: $ ________ PERSONAL ACCOUNT CHARGES FOR REIMBURSEMENT Airfare: $ ________ *Lodging: $ ________ **Enterprise or National compact-sized auto rental: $ ________ Conference registration fee: $ ________ Conference link: Personal vehicle used? Home /point of origin address: _____________________________________________________ • _____ miles @ 44.5 cents per mile (map mileage outside TLH city limits) • _____ miles @ 44.5 cents per mile (vicinity miles within TLH city limits) i.e. driving from home to TLH airport outside of normal business hours Meals: Traveler is entitled to max. $36 /day if meals are not provided for free by conference/meeting host (excludes last day of travel- entitled to max. $80 per diem on last day of travel) Breakfast: ____ days @ ____ per day ($ 6 in US) $ ________ Lunch: ____ days @ ____ per day ($ 11 in US) $ _________ Dinner: ____ days @ ____ per day ($ 19 in US) $ _________ Other anticipated costs: (Tolls, taxis, gas receipts, parking, etc.) $ _________ estimated TOTAL out of pocket: $ _________ PLEASE NOTE: *Lodging: • Lodging room rate for State Sponsored events may not exceed $1 75 per night, but be prepared to justify single room rates that exceed $1 75 per night regardless of funding source. • Reimbursement is limited to single occupancy rooms unless accommodations are shared by more than one authorized traveler. **FSU pays for COMPACT-sized car rentals only. Click here for FSU Avis rental portal or contact Quinny for auto reservation. No GPS or upgrades allowed unless justification can be made (i.e. multiple travelers [+4], transport of equipment/ display materials, etc.) If a larger car is preferred, you must pay out of pocket and seek reimbursement at the compact rate after the travel. Other: • Do not use FL SunPass for tolls. • Save all receipts/ travel docs. for reimbursement. Meal receipts are not necessary. Emily Pridgen | CAPS, FLORIDA STATE UNIVERSITY