W911SA25Q3029 Attachment 3 - Travel Request Form.pdf

Department:

CLIN:

Dates of Travel: Requeseted by Government: Yes No

Course Information: School/Institution:

Course Name:

Address of Work/Training: County:

Yes No https://www.defensetravel.dod.mil/site/perdiemCalc.cfm

Course Fee

Hotel (not to exceed per diem rate for destination) X Days =

X Days =

Transportation (Check all that apply):

GSA Vehicle =

Personal vehicle mielage (at current POV rate): rate X miles =

Baggage Fees: =

Parking fees / Other - Specify: =

Date:

Date:

Date:

Date:

Contract Number:

Employee Name: Employee ID:

Purpose of Travel & PWS Paragraph:

Do you have, and are you willing to use a personal credit card if needed:

(You would be reimbursed for all applicable costs incurred on credit card.)

Estimated Costs Involved (Check all that apply):

Travel Days: Non-Travel Days:

Rental Vehicle (Unless justification approved by KO, compact car will be used, no insurance)

Estimated fuel for rental vehicle (no prepaid option unless approved by KO)

Per Diem Rate:

Taxes per day:

- Prefered Hotel with address

ME&I (Not to exceed per diem rate for destination - Travel Days @ 75%) Per Diem Rate:

Total Lodging

Public Transportation (airport shuttle, bus, metro, train, etc.)

Airfare (update cost of actual exceeds estimated through email to KO through COR)

Home Address:

Total Transportation:

Cell Phone: Work Phone:

Emergency POC:

Home Phone: Email Address:

***For Per Diem Rates use:

TRAVEL/TRAINING Authorization Form

Travel to/from:

KO Approval:

Employee Signature:

Project Manager Approval:

COR Approval:

Preferred Departure City:

Preferred Destination City:

Grand Total:

https://www.defensetravel.dod.mil/site/perdiemCalc.cfm

Sheet1