Updated Travel Expense
Reimbursement Form

Complete this form if you attended a meeting, training, or event and are approved for reimbursement of those expenses from AHHA. If you have not submitted a Travel Authorization Request, please complete that form first.

Questions? Contact Debbie Lowenthal at dlowenthal@alaskahha .org.

Enter today's date

Name of Event

Please verify if the payment is going to you or to the facility.

Has an AHHA Travel Authorization Form for this travel been submitted?

Yes

Facility Name

First name

Person who traveled and is requesting reimbursement.

Last name

Person who traveled and is requesting reimbursement.

Traveler's email address

Email address of person completing this form

Only needed if person requesting reimbursement is not the traveler.

Travel Expenses

Date you left your community/home.

Date you returned to your community/home.

Personal travel

If applicable, enter the number of days during the above time span that were for personal travel.

How did you travel to the event?

Air

Car

Ferry

No reimbursement needed for travel

Event Expenses

Enter the amount to be reimbursed for registration fees

Enter your hotel expense

Enter the total cost of the hotel excluding any personal days or extra fees beyond the nightly rate. Include the receipt with your attached file. Max reimbursement is what is listed on your travel rules. If your hotel exceeds this amount you or your facility is responsible for the additional cost.

Daily Allowance

You will be given a minimum $50 daily allowance that applies to the event and travel days to defray the cost of additional expenses including meals, baggage fees, transportation within the venue city or other travel-related expenses. Most AHHA events include a hotel breakfast and lunch at the venue. Review your travel rules for the confirmed daily allowance allotted.

Total Expenses & Receipts

Total amount of all expenses to be reimbursed by AHHA.

Please put here the sum total of expenses to be reimbursed including airfare/ferry/mileage, lodging, registration fees, and daily allowance.

If applicable, use this space to explain why your travel deviated from the rules of the travel authorization

For example, a flight was canceled necessitating an extra night's hotel stay.

Upload your Receipts

Please enter a PDF of your hotel and airfare receipt here.

Drop your files here

Any additional information to add?

Send me a copy of my responses

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Updated Travel Expense Reimbursement Form

Travel Expenses

Event Expenses

Daily Allowance

Total Expenses & Receipts

Updated Travel Expense
Reimbursement Form