APPENDIX CnvanhoosDiane L. Wolfe202007-07-17T20:25:00Z2008-04-01T17:58:00Z2008-04-01T17:58:00Z12071183County of Albemarle92138811.0000APPENDIX CPIEDMONT REGIONAL EDUCATION PROGRAMCHARLOTTESVILLE, VIRGINIA 22901REQUEST FOR REIMBURSEMENT OF CONFERENCE/PROFESSIONAL ACTIVITY EXPENSESEmployee______________________________________School__________________________Name of Conference or Activity ____________________________________________________Place _________________________________Dates___________________________ TransportationAttach Bill ifBy CommonCarrierITEMIZATION OF EXPENSESCommon Carrier/School Owned VehicleFrom:To:Date(s)AmountPrivate VehicleFrom:To:Mileage (roundtrip) _______ x 0.485Subsistence(Not to exceed$25.00 per day for meals and 15% maximumgratuity) unlessprior approvalreceivedLodging (Attach Room Bill)BreakfastLunchDinnerOther ExpensesParking Costs, Highway Tolls, Registration Fees (attach receipts)TOTAL EXPENSES$Attach all copies of hotel bills, parking lot receipts, registration fee receipts, bills from common carriers and any other receipts for which you are requesting reimbursement.I hereby certify that the above is just, due and payable:Employee _______________________________ Date: _________________________Principal/Coordinator ______________________Date: _________________________Executive Director ________________________Date: _________________________