Mileage Reimbursement Instructions
Fill in completely the information requested. Claim must be signed by claimant and by the person authorized to approve the claim.
Employee's Information: Print your name, employee I.D. number, phone number, campus location, department and position.
Dates Covered By Claim: Insert month and year for which you are claiming mileage reimbursement.
Account Number: Insert the account number to be charged. Claims without account number cannot be processed.
Date: Insert the date of the trip.
Miles Driven: Insert the actual mileage driven and attach a copy of Google Maps or similar online navigation printout supporting all mileage claims for trips over five (5) miles.
Destination: Insert the name and full street address of your destination. Origin is the place from which you start your trip.
Reimbursement cannot be paid if the address is not inserted under destination.
Full street addresses for repeat From or To locations need only be identified for the first instance, per claim form.
Purpose of Trip: State briefly and clearly the nature of each trip. Be specific.
Signature of administrator: The claimant cannot be the approving person.
One-way = O/W
Round-trip = R/T