DREI'98 Travel Reimbursement Form


       Name (please print):________________________________________________________________

             Email address:________________________________________________________________

Address to which check should be mailed:____________________________________________________

_____________________________________________________________________________________________


To process your reimbursement you MUST do the following:
  1. Attach ORIGINAL receipts
  2. Sign this form at bottom
  3. Return reimbursement form and receipts to:
DIMACS, CoRE Bldg., Rm. 430 Rutgers, The State University of New Jersey 96 Frelinghuysen Road Piscataway, NJ 08854-8018 Attn: DREI Program Coordinator
Questions? drei@dimacs.rutgers.edu (732) 445-4631 (Note: reimbursements take approximately four weeks to process.)

Airfare (U.S. airline only):______________________________________________ Mileage (@25 cents per mile):________________________ (please list start point:______________________________________________ and destination.):______________________________________________ Other costs (describe item and enter amount on same line): Item#1:______________________________________________________________________ Item#2:______________________________________________________________________ Item#3:______________________________________________________________________ Item#4:______________________________________________________________________ Item#5:______________________________________________________________________ Item#6:______________________________________________________________________ Item#7:______________________________________________________________________ Item#8:______________________________________________________________________
I certify that the attached receipts are appropriate and accurate.


Signature

You may use this as a template - fill in the information, print it out, sign the form, then mail it along with your original receipts, to me.


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