ER# for staff use only

Travel Reimbursement Worksheet Center for Experiential Learning

11/25/19
Date:___________ Ellen Perleberg
Traveler’s Name:__________________________________________________ eperly@uw.edu
email:____________________________________________________
(509) 670-9032
Phone:___________________________ Hansee Hall A221, 4294 Whitman Ln NE, Seattle, WA State________
Mailing Address:____________________________________________________________ WA 98195
Zip_______________

UW Employee? Yes No UW Student? Yes No UW Budget: ______________ If not a UW Student or a UW Employee : US Citizen Yes No

Are you a UW Visa card holder? Yes No If yes, was the card used for this trip? Yes No Was UW Travel Account used for this trip Yes No
Middle Eastern Studies Association Annual Meeting,
Purpose of trip (please give dates and location, as well as title of meeting or conference, if applicable):__________________________________________________________
New Orleans, LA, November 13-18 (flew in overnight of 12th)
_____________________________________________________________________________________________________________________________ ________________
_____________________________________________________________________________________________________________________________________________
Was personal travel included? Yes No If so please provide details: _____________________________________________________________________________
_____________________________________________________________________________________________________________________________ ______________
Were any meals provided for you? Yes No If yes, provide date (s)and meal(s) ________________________________________________________________
Depart Return Reimb. for meals, (X in box) Lodging Miles
Date Location From Location To Lodging Name
Time * Time B-fast Lunch Dinner Amount driven

Other Expenses (i.e airfare, ferry, registration, parking, shuttle, internet access, check baggage, etc)
Expense Amount Expense Amount Expense Amount

Airfare $570.30
Check baggage $30.00

* The departure time is the time you left your house. This can be up to 3 hours prior to flight time. Your final return time should be the time you arrive at home.
Submit the form along with your original receipts to Christine Muongchanh, Center for Experiential Learning and Diversity, Box 352803, Seattle, WA 98195.
E-Travel Reimbursement Worksheet updated: 08/13/14