NESCSO Travel Reimbursement Program - Pre-travel Authorization Request

To submit your request for authorization to attend a conference and receive a reimbursement from NESCSO please complete the two (2) steps below.

Question Title

* 1. Please provide your contact information (workplace) below.

Name

Agency

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Please provide us with information regarding the conference that you would like to attend.

Name of Conference

Location

Dates

Conference Website

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* 3. Please provide us with the estimated costs for your travel.

Registration fee

Home airport travel (e.g., mileage @ $.625 per mile, cab)/Parking

Airfare

Destination airport travel (e.g., cab)

Hotel (per diem rate)

Question Title

* 4. By typing your name and date below you are certifying that the information entered above regarding travel costs is true and accurate, and is directly related to an educational opportunity related to my work within the State agency. I further certify that I will not be seeking reimbursement from any other source (e.g., employer, conference organizers) for my travel expenses.

Full Name

Title

State Agency

Date