INDIANA UNIVERSITY OUT OF STATE
DEPARTMENT TRAVEL AUTHORIZATION

TICKET CHARGED TO IU ACCOUNT Yes ( ) No ( )

Dept. Code_________Request #__________ Campus Code _____

If yes, don't send this form to Travel (unless attached to a prepaid registration)

*Keep ORIGINAL of this form - send PHOTOCOPY

Name: _______________________________ Net ID: ___________________________

Department: ____________________________________________________________

Campus Address: ___________________Campus: ____ Phone: ___________________

Purpose: ________________________________________________________________

Means of Travel: _______________ Destination: ________________________
Dates of Travel: ___________________________
Has a check request been processed for:
Prepaid Registration ? Amount________ DV# ____________ Date: ______________

Additional Notes:
Cost of airline ticket: ____________________ *All passenger ticket receipts must be
Name of Conference: _____________________ turned in with reimbursement request.
Actual Conference Dates: ___________________
Preparer's Name/Phone: ___________________________

SIGNED:(applicant)_______________________
APPROVED:(account manager)__________________________
Note: Travel by private auto requires the traveler to carry the following:
1. $50,000 for personal injury to, or death of, one person
2. $100,000 for injury to, or death of, more persons in one accident
3. $25,000 for property damage