Faculty Travel Request Form

FACULTY TRAVEL REQUEST FORM

Please submit at least four weeks before departure.

First name:

PERSONAL INFORMATION

Name
Suffolk Email Address Verify Suffolk Email
Phone	- -

Travel
Dates of Travel mm/dd/yyyy
Please be advised: Four weeks advance notice is required for approval of travel funds. The Dean's Office may not be able to authorize any untimely request without an explanation of the delay. Your departure date should be later than 06/20/2012.
Destination
Event
Nature of Participation If Reason for travel is other, please explain

Estimated Travel Costs
	Enter 0 where applicable
Air / Transportation to Event	$
Hotel (Include all taxes)	$
Mileage	$
Meals (Daily Maximum $85.00)	$
Registration (Please request waiver from sponsor whenever possible)	$
Other (Please provide details in "Other Information" box below)	$
Total	$

EXTERNAL FUNDING
Grant or External Funding	Yes No
If Yes	$

ADDITIONAL INFORMATION
Explanatory Memo
Academic or administrative purpose of the trip; Conference, workshop, meeting or session to be attended; Papers to be presented or panels to participate (where relevant); Academic or administrative benefits to be obtained.


Other Information (optional)


Please note: All fields are required, unless noted otherwise.

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