The University of Georgia-Athens, Georgia 30602 Request for Authority to Travel on Official University Business (For out of State travel only) NOTICE: Please notify the Accounts Payable Department in writing if this authority has been incumbered and then is not exercised. NOTICE: The full 9 digit social security number will have to be provided in order for the request to be processed.

Authority No: 1129253

Traveler's Name:

Social Security No:

Department:

University Employee: ____ Yes ____No

Account Number(s)

Do Not Use This Space

Name of Account(s)

Amount

Fiscal Year

A.

B.

C.

Itemized estimate of costs Meals:                  Lodging:              Transportation:    Other (explain):             ================================== TOTAL*

*Reimbursement to traveler cannot exceed amount allowable under University Travel Regulations. Time of Departure:   Mode of Travel:

Nature of Official Business:

Dates to be absent from campus:

Please provide detailed justification for the travel:

Address while absent:

Means of handling classes and other business while absent:

Indicate below if traveler wants air travel expense charged directly to the University.   *Upon encumbrance of this authorization, the traveler may make reservations and arrange for issuance of tickets with local travel agency.

Name of authorized travel agency:

Dept. Contact:

Email:

Phone:

Traveler's Signature: ___________________________________   Date: _________________________ Department Head: ______________________________________  Date: _________________________ Dean or Director:_______________________________________   Date: _________________________ Vice President: ________________________________________   Date: _________________________ President: ____________________________________________    Date: _________________________