Out-Of-State Trip Application	TRAV-210 3-23-2016
For Financial Services Use Only	Account #	Authorization #	Advance
1. Name and Title	2. Employee I.D.	3. Destination
4. Meeting Place	5. Depart From	6. Return to
7. Purpose of trip
8. Type of trip	Official Extension Business	Conference or Training
Date of last Professional Improvement Trip
9. Request Authorization For	Full Expense	Part Expense	Official time only
10. Time	Time	From Date	Time	To Date	No. of Days
Dates of Trip
Dates of Meeting
Official Time (workdays)
Official Time (weekends/holidays)
Personal Time
Annual Leave
11. Estimated costs	Direct to	Direct to	12. Transportation Data
Traveler	Organization	Air
Transportation	Auto	Miles @ 42	$0.00
Bus
Air	Bus
Extension or UA Vehicle
Taxi/shuttle
Rental Car (Attach justification
Signed by Travel Administrator) See Below	Private Auto, Claiming:
Registration Fee	Mileage
Air fare in lieu of mileage
Lodging	days	No Charge
Meals	days	Auto Furnished by
Other (Specify)
Total	$0.00	$0.00	Passengers who are also
Rental Cars: Must use mandatory state contract vendors (Enterprise, National, Hertz)
State employees
Travel Advance Requested
Do you have a state issued travel card? Yes No
13. Fund Number	14. Fund Name
15. Organization Number	16. Who to contact for questions
Remarks
Signature of	Official Station:
Applicant	Date
Supervisor	Date
Director/Travel
Administrator	Date

This form should be submitted at least 2 weeks before travel.

Upon completion of trip, an expense account (TRAV-207) should be submitted.