Please add the date when this form was completed and sent.

Provide the complete name as shown on your official identification. Especially important when traveling by air.

R12345678

Please state if you are with NWI or Renewable Energy.

List the name of your travel destination, city, state, and country, if appropriate,

List name of your supervisor.

List the location of where your trip begins.

Select the department responsible for the travel

What date are you departing and what time. If traveling by air, this is the date and time of your departing flight.

What date are you returning and what time. If traveling by air, this is the date and time of your returning flight.

18B002-E04001-200 ex: (fund-org-program)

Use https://www.mapquest.com/ to determine the mileage to use. Please multiply total miles estimated to be driven multiplied by .655 cents per mile. ( i.e. 10 miles x .655 = $6.55)

Please check the per diem rates for your destination. Using that information, please include the estimated lodging expense. *If appropriate, ask for State Rates when making lodging reservation. If State Rates not available, a TRAVEL EXCEPTION FORM will need to be filled out and signed by additional signatures prior to submission of the Travel Application.

WARNING: If the Travel Card is utilized for registration, Traveler may not be reimbursed the total amount paid for registration if registration is cancelled. To assure a full refund of all registration fees, utilize the department pcard.

Check the per diem total for your travel destination. Using that information include your estimated meal expense.

By signing this form, you are authorizing your Travel Coordinator to submit a Travel Application on your behalf.