Flex Yes – Grant Programs Expense Report Grant Programs Expense Report For reimbursement, please complete this form according to the Grant Program Expense Guidelines and submit with ORIGINAL ITEMIZED, NUMBERED RECEIPTS. Please provide details of your mileage request and for all trips over 50 miles one way, include an online map itinerary with mileage approximation. Mileage should be calculated at a rate of $0.575 per mile.Expense Report #(Required)Date(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Date of Activity(Required) MM slash DD slash YYYY Location(Required)Activity TypeHalf DayFull DayMulti DayTotal # of Adults(Required)Total # of Chaperones(Required)Total Number of Grant Students(Required)Total # of Students(Required)Indicate Students and their ActivitiesStudent Orientation & MeetingsArrivalCheckFLEX #YES #Mid-YearCheckFLEX #YES #Re-EntryCheckFLEX #YES #Host OrientationsArrivalCheckFLEX #YES #Re-EntryCheckFLEX #YES #Enhancement ActivitiesActivity 1 – Semester 1CheckFLEX #YES #Activity 2- Semester 1CheckFLEX #YES #Activity 3- Semester 2CheckFLEX #YES #Activity 4- Semester 2CheckFLEX #YES #Activity TypeHalf DayFull DayMulti DayOther Expenses (Please Explain)Explanation of ActivitiesPlease choose how many expenses you are submitting(Required)12345678910Date MM slash DD slash YYYY LocationExplanation of ExpensesTotal ExpenseFileMax. file size: 80 MB.Mileage Record SheetPlease choose how many mileage requests you are submitting(Required)12345678910Date MM slash DD slash YYYY FromToDescription of TravelMileageAuto Calculated Amount * $.0575Section BreakTotal Expenses (Calculated)Total Mileage (Calculated)Total Amount Due (Calculated) Δ
