INDIVIDUAL STAFF TRAVEL REQUEST

APPLICANT  _______________________________________ SOCIAL SECURITY #  ___________________________________

HOME ADDRESS  _____________________________________________________________________________   ZIP ________   

APPROVAL

Dept. Head	_____Yes  _____No

Asst. Director_____Yes  _____No
 
Director          _____Yes _____No

Decision	_________________

Amount Approved $____________  

NAME OF MEETING  ____________________________________________

		          ____________________________________________	

ORGANIZATION  _______________________________________________	

	MEMBER  ________  Yes	________  No

	DATES  ________________________________________________

	PLACE  ________________________________________________

CATEGORY:  ________  Conference	________  Meeting

	          ________  Workshop	________  Visiting

ESTIMATED TRANSPORTATION COSTS:	____________________

COMMENTS

Dept. Head ___________________

_____________________________

_____________________________

Asst. Director_________________

_____________________________

_____________________________

Director _____________________

_____________________________

_____________________________

OTHER EXPENSES:		Registration Fees	____________________

				Lodging		____________________

				Other (Specify)	____________________

						____________________

				Total Amt. Requested_________________

TIME REQUESTED:  _____________________________________________

Please state briefly the benefits accruing to you and the library:

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