Travel & Reimbursement Request Form

The AISC Travel & Reimbursement form must be filled out completely and submitted to us before any reimbursement requests can be processed.

  • Download the form (PDF) - Please use Adobe Reader to complete the form. You can download Adobe Reader for free.
    This form was last updated on January 2018. Please note the form is subject to change as items, such as mileage rates, can change.

Please mail us the completed form and receipts to our office:

UCLA American Indian Studies Center
Reimbursements Request
3220 Campbell Hall
Box 951548
Los Angeles, CA 90095-1548

Form Field Explanations

Date Enter the date you are filling this form
Name First and Last name
UID This field is only for UCLA employees. Please leave blank if it does not pertain to you
Title Job title / Student
Affiliation Company / Organization
Email A working email that we can use to contact you if we have questions about your reimbursement request
Phone A working phone number that we can use to contact you if we have questions about your reimbursement request
Address The address you wish the reimbursement check will be delivered to (for Non-UCLA employees only)
   
Meeting/Event Title Name of the meeting or event you traveled to
Dates of Travel Start date and End date
Business Justification Provide a who, what, when, and why (For example, Joe Bruin attended the annual conference at Santa Fe, New Mexico to speak on a panel)
Signature Please sign the form to approve all expenditures
   
Air Amount for your air travel - only the coach rate is reimbursable. You will not be reimbursed for any upgrades you incur
Rental Car + Gas Amount for rental car and gas (if applicable) combined
Car travel If you used your personal vehicle, mileage will be reimbursed (not gas)
Ground transportation Amount for any ground transportation. Any luxurious transportation (such as a limousine) will not be reimbursed without a proper business justification.
Lodging Amount for your hotel stay
Meals & Incidentals All meals and incidentals incurred during your travel
Other expenses Amount for other expenses incurred during your travel, such as baggage fee, unrelated to the categories above
   
Expense Not Related to Meeting and Travel Expenses reimbursement requests that was not incurred during your travel dates

If you are having trouble with the form, please contact Jamie Chan at jchan@aisc.ucla.edu