The Gail & Richard Lumpkin School of Nursing - Travel Application Form

Please fill out this form and submit at least 2 weeks prior to travel.

EIU Travel Info: https://www.eiu.edu/purchasing/travel.php

Today's Date Today's Date * / MM / DD YYYY
Name Name * First Last
Email *
Checkboxes - check only one *

Checkboxes - check only one Employee Only Attending Employee Presenting/Mentoring
Purpose of Travel: *
Destination *
Departure Date Departure Date * / MM / DD YYYY
Return Date Return Date * / MM / DD YYYY
Are you planning on taking your personal vehicle or university vehicle?

Are you planning on taking your personal vehicle or university vehicle? Personal Vehicle University Vehicle
Estimated Mileage Amount (Only if you are taking your personal vehicle) $ Dollars . Cents
Will this require other types of transportation?

Will this require other types of transportation? Flight Taxi/Uber Other Other
Estimated Cost for Transportation * $ Dollars . Cents
Lodging - if overnight. ($28/day in-state, $32/day out-of state)

Illinois preferred hotels can be found here: https://cms.illinois.gov/employees/travel.html

Per Diem/Hotel allowances: https://cms.illinois.gov/employees/travel/travelreimbursement.html * $ Dollars . Cents
Extra Expenses - tolls, parking... * $ Dollars . Cents
Registration Fees * $ Dollars . Cents
Funding Source *

Funding Source School of Nursing Funds Out of Pocket