Faculty - Travel Reimbursement Form First Name * Last Name * KU Employee I.D. Number * This number can be found on your paystub. Mailing Address * City * State * - Select -AF Africa/CAN/Europe/MEAF PacificAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaCOloradoConnecticutDelawareDistrict of ColumbiaF.S.of MicronesiaFLoridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNo.Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Phone Number * Email Address * Job Title Department Office Street Address * Office City * Office Zip Code * Course Number * Ex. BUS 890 Miles (One Way) * Dates Traveled * You must provide the specific dates and reasons you were on campus in order to receive reimbursement. Please write each exact date and reason in the box above. Tolls Paid Yes If selected, please specify amount below and Bus Passes state: Please turn bus passes in at Front Desk Regnier Hall on the Edwards Campus. Amount Paid $ Bus Passes Yes Please turn bus passes in to Lawrence Subelka in Regnier Hall on the Edwards Campus. Beginning address * Ending address * Beginning address (if multiple trips occurred) Ending address (if multiple trips occurred) Attach receipts, etc. Files must be less than 2 MB.Allowed file types: gif jpg png html pdf doc docx ppt pptx xls. Attach Map Quest map Files must be less than 2 MB.Allowed file types: gif jpg png html pdf doc docx ppt pptx xls.