Please submit your requests for travel reimbursement by filling out and submitting the items on this form. Items marked with a red asterisk are required. Please contact us with any questions about your requests. Personal information Name * Email * Phone * Enter your phone number in any format. Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Country * United StatesAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Zip code * Name of assistant (if applicable) Reimbursement details Request reimbursement for * Corporation meeting Visting Committee meeting Other Which Corporation Meeting is this for? Which Visiting Committee Meeting is this for? What is this reimbursement for? Trip start date * Year Year20212022202320242025 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Trip end date * Year Year20212022202320242025 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Expense details Expense 1 - None -AirfareGround TransportationLodgingMealsOther Expense 1 value $ Describe this expense Expense 2 - None -AirfareGround TransportationLodgingMealsOther Expense 2 value $ Describe this expense 2 Expense 3 - None -AirfareGround TransportationLodgingMealsOther Expense 3 value $ Describe this expense 3 Expense 4 - None -AirfareGround TransportationLodgingMealsOther Expense 4 value $ Describe this expense 4 Expense 5 - None -AirfareGround TransportationLodgingMealsOther Expense 5 value $ Describe this expense 5 Expense 6 - None -AirfareGround TransportationLodgingMealsOther Expense 6 value $ Describe this expense 6 Expense 7 - None -AirfareGround TransportationLodgingMealsOther Expense 7 value $ Describe this expense 7 Expense 8 - None -AirfareGround TransportationLodgingMealsOther Expense 8 value $ Describe this expense 8 Expense 9 - None -AirfareGround TransportationLodgingMealsOther Expense 9 value $ Describe this expense 9 Expense 10 - None -AirfareGround TransportationLodgingMealsOther Expense 10 value $ Describe this expense 10 Expense 11 - None -AirfareGround TransportationLodgingMealsOther Expense 11 value $ Describe this expense 11 Expense 12 - None -AirfareGround TransportationLodgingMealsOther Expense 12 value $ Describe this expense 12 Expense 13 - None -AirfareGround TransportationLodgingMealsOther Expense 13 value $ Describe this expense 13 Expense 14 - None -AirfareGround TransportationLodgingMealsOther Expense 14 value $ Describe this expense 14 Expense 15 - None -AirfareGround TransportationLodgingMealsOther Expense 15 value $ Describe this expense 15 Enter the approximate mileage in whole numbers you travelled in a private automiobile. MIT will reimburse you at the prevailaing IRS rate of $.54 per mile. Estimated mileage miles Send your receipts Please send electronic copies of your receipts to us at nduenn@mit.edu. We are no longer able to accept uploaded files due to security concerns. Use the field below for any comments or details you think may be helpful. Comments When you have completed all applicable sections, please select the Submit button to forward your information to the Corporation office. What code is in the image? * Enter the characters shown in the image.
