Transportation Request (Form 1)

Driver:

Check if a student

Department:

Fund:

Cost Center:

SIO:

Internal Order:

G/L Account:

Destination(s): (Please include city and state)

Purpose of Trip:

Name all persons accompanying driver. (Please list names only)

Start Date/Time:

End Date/Time:

Vehicle Requested:

Special Arrangements:

Official Mileage to and from primary destination:

Estimated local mileage at destination:

Total estimated miles:

Certification: This trip has been authorized by the president’s office under Pres. Form 17 (Rev) or 17B and provision has been made for payment in the budget of account indicated. The designated driver is a responsible employee of the University and possesses a valid Operator’s‚ Chauffeur’s or Public Passenger Chauffer’s License issued by any of the fifty states to operate the type of vehicle provided and is familiar with the rules and regulations governing operation and use of University vehicles. Note: No one other than employees named on this form who meet all university requirements is authorized to drive the vehicle. The vehicle will be used only to further the business of the university.

By checking this box, I am certifying that: this request is for official university travel, it has been approved by the Department Head, Dean, or Director of my department, I am aware that I am responsible for any allowable travel expenses incurred during official university travel, and I understand the approval of any travel related expenses for reimbursement will be subject to the approval by the Department Head, Dean, or Director of my department upon return.

Note: After the form is filled out, please print a copy for your records before submitting the form. To avoid duplication errors, please only submit this form electronically.