ASFCCC Expense Reimbursement Form

Please note: a reimbursement request must be SUBMITTED no later than 20 days following the event for which the expenses were incurred, OR No later than July 10th for events occurring between June 1st-30th. Requests received after the applicable deadline will NOT be honored.

If you have any questions, please contact accountant [at] asccc.org (accountant[at]asccc[dot]org)

Name

Your College

Mailing Address

City, State, & Zip

Day Phone

Email Address

Dates of Travel

Purpose of Travel

Destination

Person in Charge of Meeting

Expenses

	SUN	MON	TUE	WED	THU	FRI	SAT	Line Total
Date	Date1	Date2	Date3	Date4	Date5	Date6	Date7
*Meals (Max Daily $54)	Meals1	Meals2	Meals3	Meals4	Meals5	Meals6	Meals7	subtotal_meals $0.00
Lodging	Lodging1	Lodging2	Lodging3	Lodging4	Lodging5	Lodging6	Lodging7	subtotal_lodging $0.00
Rideshare/Taxi	Rideshare1	Rideshare2	Rideshare3	Rideshare4	Rideshare5	Rideshare6	Rideshare7	subtotal_rideshare $0.00
Airfare/Train	Airfare1	Airfare2	Airfare3	Airfare4	Airfare5	Airfare6	Airfare7	subtotal_airfare $0.00
Parking	Parking1	Parking2	Parking3	Parking4	Parking5	Parking6	Parking7	subtotal_parking $0.00
**Incidentals $5/day	Incidentals1	Incidentals2	Incidentals3	Incidentals4	Incidentals5	Incidentals6	Incidentals7	subtotal_incidentals $0.00
Number of Miles	Miles1	Miles2	Miles3	Miles4	Miles5	Miles6	Miles7	subtotal_miles 0.0
Mileage ***$0.67/mi	mileage1 $0.00	mileage2 $0.00	mileage3 $0.00	mileage4 $0.00	mileage5 $0.00	mileage6 $0.00	mileage7 $0.00	subtotal_mileage $0.00
Totals	subtotal_day_1 $0.00	subtotal_day_2 $0.00	subtotal_day_3 $0.00	subtotal_day_4 $0.00	subtotal_day_5 $0.00	subtotal_day_6 $0.00	subtotal_day_7 $0.00	grand_total $0.00

Check here if ASFCCC paid for flight or hotel arrangements. Do not include in costs above.

Other Expenses: Must include full description below and itemized receipts to be eligible for reimbursement.

Vendor	Purpose	Amount
description_1	purpose_1	amount_1
description_2	purpose_2	amount_2
	Grand Total:	Grand Total $0.00

* Itemized receipts required for all claimed expenses. Meals paid at actual receipt amount, up to maximum. ASFCCC does not pay a per diem. Refer to our Expense Reimbursement Policy for allowable travel reimbursements.
** Incidentals permitted for ASCCC Executive Committee Only.
*** Upload a route map to support total miles requested for reimbursement. Max Mileage reimbursement $300. See Expense Reimbursement Policy.

Notes

I certify that I incurred the costs above and all itemized receipts and reports are attached, as necessary, and that all expenses submitted are for business related to Foundation of the Academic Senate for California Community Colleges activities.

Upload Receipt

Maximum 20 files.
20 MB limit.
Allowed types: pdf, jpg, jpeg, png, doc, docx.

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