Department of RadiologyResearch Travel Authorization Request Form

Department of Radiology

Research Travel Authorization Request Form

Please fill out this form to request approval of your upcoming business trip. If the PI is funding the trip, please provide a ST# .

The form goes to the PI/Supervisor for approval, then to appropriate funding source approvers (i.e. Section Heads if you are using Section funds). The Vice Chair of Research is the final approval.

To find out the status, submit receipts after the trip for reimbursement, please go to Radiology Research Dashboard:

https://app.smartsheet.com/b/publish?EQBCT=fc9c819fd1614b428ee24d2097c4a1af

under 'Smartsheet Reports"
select "Radiology Research Travel Authorization Report" (by requestor or PI - must log in w/ CU email/credentials) or through this link: https://app.smartsheet.com/reports/R53Gcv8q4QvJwVJHJjpgjM86rhhxjhr2c66GVqJ1

Questions?

Smartsheet form/research ST#/grant-related inquiries:

Victoria Bress, email: victoria.bress@cuanschutz.edu

Travel coordination/reimbursement: (assigned Prog Asst)

Emma Agatston, email: emma.agatston@cuanschutz.edu

Nadine Lucero, email: nadine.lucero@cuanschutz.edu

Tori Rodriguez, email: tori.rodriguez@cuanschutz.edu

Thank you

Requestor (Last, First Name)*

Requestor Email*

Have you submitted a Leave Request Form?*

Dept of Radiology Research/PhD faculty, Postdocs, and select Research staff only:

**for "Professional Time Off" Leave Request Form**

please fill out a Radiology Research Leave Request Form:

https://app.smartsheet.com/b/form/44df108ec5d440c29587129e99ca872c

The form will get routed to your PI/Supervisor, then Vice Chair Research for approval.

Our Program Assistant/s will confirm if a Leave Request is submitted. Assistance with travel will be provided.

Radiology employees using 'MyLeave' in submitting leave requests, please use that platform to go with this professional travel request.

If you are not a Dept of Radiology employee (i.e. medical student, other department employee, etc.) but this travel is funded by Radiology, select "no" .

Select

Requestor Supervisor or PI (Last, First Name)*

Requestor Supervisor or PI Email*

Please make sure you enter the correct email address, as this form is automatically sent to the PI for approval.

Additional Approver Email 1 (if split funding)

If funding source is Section or department, please enter the Section Head or the department approver email address.

Additional Approver Email 2 (if split funding)

If additional funding source is Section or department, please enter the Section Head or the department approver email address.

Business Purpose of the Trip*

Funding Source (PI funds, Section, Grant, etc.)*

Please don't forget to upload any supporting documentation at the bottom of this page (i.e. PI/Section Head approval with ST#, grant/project, research start up, etc.). You can identify if it's 100% funded by PI, or Section, or 50/50 PI/Section, etc.

Speedtype #

if you know it

Conference Name*

Don't forget to upload a copy of the conference flyer

Conference Location (City, State)*

Don't forget to upload a copy of the conference flyer

Conference Website*

Copy and paste the URL

Conference Start Date*

Don't forget to upload a copy of the conference flyer

Conference End Date*

Departure Date*

Return Date*

Anticipated Conference Registration Fees*

Anticipated Airfare*

Anticipated Hotel Rate per Night*

(see Dept of Radiology Travel Policy, rate is capped at the conference hotel host rate)

# of Hotel Nights*

Per Diem Rate (based on conference location)*

Per diem rate is based on the city of your destination (i.e. conference).

To find out the per diem rate, click here: U.S. General Services Administration (GSA)

Per diem rate, "M&IE Total" is broken down by each meal: breakfast, lunch, dinner, plus incidental expense (i.e. tip). Travel day is 75% of per diem rate.

Anticipated Transportation (to/from airport/hotel)*

(see Dept of Radiology Travel Policy, no more than 4 cab/Uber, shuttle fares per trip, includes: to/from airport/hotel; DIA parking is allowed in lieu of cab fare to/from DIA; cab fares during conference to restaurants are not reimbursable)

Anticipated Other (i.e. poster printing)*

Set Budget/Allowance*

If your Supervisor/PI has given you an allowance for this trip, please indicate the amount here. If there is no set budget, the calculated anticipated total cost will be the set budget. (see **Attention** below to find out est anticipated total cost)

If you have a set budget/allowance and the actual total expense cost (after the trip) is more than the anticipated or budgeted cost, your PI needs to approve the surplus prior to finalizing the expense report (lodging, per diem, etc.)

Attention

To see the anticipated total cost (based on per diem rate, hotel rate, # of travel days, etc. submitted)
To upload receipts for reimbursement after the trip (select the row, click on the paperclip symbo, then attach documents)

click here: https://app.smartsheet.com/reports/R53Gcv8q4QvJwVJHJjpgjM86rhhxjhr2c66GVqJ1

Comment*

File Upload*

Any supporting document for this trip (i.e. conference information, PI, Section Head, or department approval to cover the costs of this trip, etc.)

If you are presenting, please attach the abstract acceptance notification.

Drag and drop files here or

Send me a copy of my responses

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