TREC Knowledge & Education Expansion Project (KEEP) Reimbursement Form Today's Date: ______1-1-01_________________________________________________ Requestor's Name: ____John Doe_________________________________________________ Street Address: ____123 Main Street____________________________________________ ____City, ST 00000_____________________________________________ TREC Center: ____(Harvard, UCSD, UPenn, or WUSTL) ______________________________ Amount Specified in Approved KEEP Proposal: $ _ 1,000.00___________ Airfare Lunch Cabs, Date or Lodging Bus, Personal Parking Car 125.00 12-32-00 123.45 101.12 150.00 38.75 12-33-00 101.12 23.45 12-34-00 101.12 22.77 12-35-00 123.45 39.10 Totals 246.90 303.36 46.22 150.00 77.85 125.00 Total Expenses (Reimbursement Requested): ____$949.33___ Requestor Signature: Date: Your Signature XX-XX-XX TREC Center Approval: TREC Center Principal Investigator or designee Date: XX-XX-XX (TREC Center Principal Investigator or designee) TREC Administrative Use Approval: Date: Notes:
TREC Knowledge & Education Expansion Project (KEEP) Reimbursement Form Today's Date: ______1-1-01_________________________________________________ Requestor's Name: ____John Doe_________________________________________________ Street Address: ____123 Main Street____________________________________________ ____City, ST 00000_____________________________________________ TREC Center: ____(Harvard, UCSD, UPenn, or WUSTL) ______________________________ Amount Specified in Approved KEEP Proposal: $ _ 1,000.00___________ Date Airfare or Personal Car Lodging Lunch Cabs, Bus, Parking 12-32-00 123.45 101.12 150.00 38.75 125.00 12-33-00 101.12 23.45 12-34-00 101.12 22.77 12-35-00 123.45 39.10 Totals 246.90 303.36 46.22 150.00 77.85 125.00 Total Expenses (Reimbursement Requested): ____$949.33___ Requestor Signature: Your Signature Date: XX-XX-XX TREC Center Approval: TREC Center Principal Investigator or designee Date: XX-XX-XX (TREC Center Principal Investigator or designee) TREC Administrative Use Approval: Date: Notes:
YR-3-Reimbursement-Form.docx