Employee Travel Expense Reimbursement Form

Travel Expense Reimbursement

Upon written request and approval, Dade Legal Aid will reimburse the reasonable, economy travel expenses of employees for pre-approved travel in connection with and in furtherance of its mission and deliverables for those who represent the organization at conferences, seminars or other functions related to their duties. You must receive pre-approval and complete this form to receive reimbursement.

Name(Required)

First Last

Email(Required)

Reason for Travel:(Required)

Meeting Attended:(Required)

City:(Required)

Travel Date Start:(Required)

Travel Date End:(Required)

Program Reimbursement(Required)

Does the program offer reimbursement?

Did you request reimbursement from them?

If you are requesting reimbursement for any of the following expenses incurred in attending an approved function please complete and attach receipts. All requests must be submitted in writing and must be supported by documentation. Mileage costs will be reimbursed at the current government rate that is approved by the funder and/or Legal Aid. Meals are reimbursed at actual cost during travel up to $15.00 breakfast, $19.00 lunch, $30.00 for dinner, when the program does not provide such meals or they are not included as part of the conference or program.

Air Total cost:

Car Total cost:

miles @ .58 cents per mile

Car Rental Total cost:

Taxi/Uber Total Cost:

Tolls Total Cost:

Parking/Valet Total cost:

Lodging # of Nights:

Lodging Total Cost:

Food Expenses Total Cost:

Other (Itemize):

Other Total Cost:

Total Expenses:

Total Reimbursement Amount Requested:

*If your "Total Reimbursement Amount Requested" is different from the "Total Expenses", please state why.

*Also any notes you may want to add.

Upload Your Receipts:

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 7 MB, Max. files: 10.

Signature(Required)

Please make check payable to:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Approved By:

Date Approved: