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Mileage Agenda Template for Reimbursement

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When reimbursement involves mileage, please use the following template as a guide for the information to attach to the expense reimbursement report. Contact the Firstsource Support Team of the ASK Center for assistance, (715-836-3131).

***Please Note: When using Google Maps or MapQuest to calculate mileage, please use 105 Garfield Ave., Eau Claire WI 54701 as your originating address. You may only use your home address if this distance is a shorter drive (less miles).

VUA: All mileage reimbursements require a Vehicle Use Agreement on file. Follow the link for more information: https://www.uwec.edu/risk-management-safety/resources/driver-authorization-vehicle-use/

Business Justification: Did you present, recruit, attend or observe? What is the main purpose, etc.?

  • Date:
    • Name of Organization/Destination:
    • Originating address, city, state:
    • Destination address, city, state:
    • Miles driven:
    • Notes:
  • Date:
    • Name of Organization/Destination:
    • Originating address, city, state:
    • Destination address, city, state:
    • Miles driven:
    • Notes:
  • Date:
    • Name of Organization/Destination:
    • Originating address, city, state:
    • Destination address, city, state:
    • Miles driven:
    • Notes:
  • Date:
    • Name of Organization/Destination:
    • Originating address, city, state:
    • Destination address, city, state:
    • Miles driven:
    • Notes:

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