Activity Expense Report PhoneThis field is for validation purposes and should be left unchanged.Requester's Name* First Last Requester's Email* Your Home School* K Center Lincoln Pierrepont RHS Union Washington BOE Office Please pick your HOME SCHOOL if you travel between buildings.Program or Workshop Name*Provider or Company Name*Location of Program* NJ Out of State Other District employees attendingPayment should be made to* Provider (Registration form required. Purchase order also required if cost is over $125) Employee (Proof of payment and proof of attendance required for reimbursement) Please select oneAddress of provider or program for reimbursement* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Purpose of program*Provide an explanation of what you learned and how it will be applied in performing your work.Registration FeeCost of the program if not paid directly by the Rutherford Public School District.MileageRound trip mileage to the program. The mileage is calculated at $0.47 per mile. Please use maps.google.com to calculate how many miles it is each way from your home or home school/building (whichever is shorter)TollsTotal cost of tolls to and from programLodgingCosts of lodging with prior approvalIs the hotel on the site of the program? Yes MealsCost of meals with prior approvalOther ExpensesPlease provide any expenses in dollars.Other expense detailsEnter details of other expenses, with prior approval.TOTAL COSTThis is automatically calculatedProof of attendance Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB. Upload any documentation to prove your attendance of this programProof of Payment Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB. Upload a picture or scan of a check, a receipt from the vendor, or a copy of a credit card bill.Mileage Report Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB. Upload a PDF of a mileage report using maps.google.com between place of work and program destinationToll Calculation Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB. Upload a PDF of a toll calculation report (for example, Parkway, Turnpike, Bridge tolls, AC Expressway, etc)