Spreadsheet: 181dbd51-5e89-4c13-bf34-6b9bcb954f18
Sheet: Sheet1

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 |  | REQUEST FOR TRAVEL AUTHORIZATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]. [NAME]. (8 pos. [NAME])
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | University #236
 | Part A --- General Information
 | Date |  |  |  |  |  |  |  | Department |  |  |  |  |  |  |  |  |  |  |  |  | Traveler E-mail /Phone |  |  |  |  |  |  |  |  | Yes |  | *Travel outside 16 domestic countries?
 |  |  |  |  |  |  |  |  | VCUarts Qatar - |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | No |  | *Domestic Countries: Bahrain/Iran/Iraq/ Jordan/ Kuwait/Lebanon/Oman/Saudi Arabia/ Syria/Turkey/ UAE/Yemen/Qatar/Egypt/       Pakistan/Palestine
 | Traveler Name |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  |  |  |  |  |  |  | Traveler Department Mailing Address
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PO Box 8095, Doha, Qatar
 | [NAME] V# |  |  |  |  |  |  | State Employee? |  |  |  |  | [NAME]**                                                                                                                                                                                                                                                     [NAME] |  |  |  |  | Give Destination and explain purpose for trip
 |  |  |  |  |  |  |  | Yes** |  |  | No** |  | [NAME]
 | Check Reason for Travel: |  |  |  |  |  |  |  |  | Method of Travel
 |  |  | State Business |  |  |  |  |  |  |  |  | Airline
 |  |  | Conference/Convent |  |  |  |  |  |  |  |  | Rail
 |  |  | Research |  |  |  |  |  |  |  |  | State Vehicle
 |  |  | Staff Training/Dev |  |  |  |  |  |  |  |  | Private Vehicle
 |  |  | Student Teaching |  |  |  |  |  |  |  |  | Other |  |  |  |  |  | Is Personal Travel included in this trip?
 |  |  | Other |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes | *Attach Foreign Travel Certification & Submit Leave Authorization Form to VCUQ HR*
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | No
 | Part B --- Travel Description
 |  |  |  |  |  |  |  | DEPARTURE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ARRIVAL |  |  |  |  |  |  |  |  |  |  | ESTIMATED
 | CITY |  |  |  |  |  |  |  |  |  |  |  | DATE |  |  | TIME |  |  |  | CITY |  |  |  |  |  |  |  |  |  |  |  | DATE |  |  | TIME |  |  |  | COST
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A.M. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A.M.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | P.M. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | P.M.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A.M. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A.M.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | P.M. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | P.M.
 | HOTEL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dates |  |  |  |  |  |  |  | Number of |  |  |  |  |  |  | Amount
 |  |  |  |  | Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  | of Stay |  |  |  |  |  |  |  | Nights |  |  |  |  |  |  | x
 | CAR RENTAL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dates |  |  |  |  |  |  |  | Total Number |  |  |  |  |  |  | Amount
 |  |  |  |  | Company |  |  |  |  |  |  |  |  |  |  |  |  |  |  | of Stay |  |  |  |  |  |  |  | of Days |  |  |  |  |  |  | x
 | MEALS
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Private Vehicle |  |  |  |  |  |  |  | miles x |  |  | 0.55 |  |  | Rate/Mile
 |  | Ground Transportation at Destination |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | miles x |  |  | 0.246 |  |  | Rate/Mile
 | Other (Registration, Parking Etc.)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Estimated Cost of Travel
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Reimbursement by Department
 | Source of Funds: |  |  |  |  |  |  | Funds for payments in Qatar |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Amount |  |  | $
 | Funds for payments outside of Qatar |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Amount |  |  | $
 |  |  |  |  |  |  |  | Other (Specify) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Amount |  |  | $
 | Part C --- Department Certification
TRAVEL ADVANCE REQUEST & REPAYMENT AGREEMENT
THIS SECTION FOR USE BY UNIVERSITY EMPLOYEES ONLY. APPROVAL SIGNATURES AS REQUIRED BY UNIVERSITY POLICY.
I request a TRAVEL ADVANCE in the amount of $ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | .   Airfare must not be included in the travel advance.  TRAVEL ADVANCES are issued FIVE (5)
DAYS PRIOR TO DEPARTURE TIME with repayment THIRTY (30) DAYS FROM DATE ISSUED. I AUTHORIZE the UNIVERSITY to DEDUCT this ADVANCE from my
paycheck, if I fail to return my advance within THIRTY (30) DAYS OF THE RETURN from my Trip.
Signature of Traveler |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
TRAVELER'S RESPONSIBILITIES
I certify that the charges to be made are reasonable, will be in accordance with State Travel Regulations, and will be limited to those required in an official capacity.
 | SIGNATURE OF TRAVELER |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME |  |  |  |  |  |  |  |  |  |  |  | DATE
 | DEPT. HEAD/DIVISION CHRMN./PI |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME |  |  |  |  |  |  |  |  |  |  |  | DATE
 | DEAN / DESIGNEE OF SCHOOL (VCUQ) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME |  |  |  |  |  |  |  |  |  |  |  | DATE
 | DEAN / DESIGNEE OF SCHOOL (VCUR) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME |  |  |  |  |  |  |  |  |  |  |  | DATE
 | VICE PRES./PRESIDENT (IF [NAME].) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME |  |  |  |  |  |  |  |  |  |  |  | DATE