{"id":21564,"date":"2022-11-16T22:58:50","date_gmt":"2022-11-16T22:58:50","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/network\/?page_id=21564"},"modified":"2026-04-15T17:04:11","modified_gmt":"2026-04-16T00:04:11","slug":"general","status":"publish","type":"page","link":"https:\/\/familymedicine.uw.edu\/network\/events\/travel-reimbursement\/general\/","title":{"rendered":"UW Employee Travel Reimbursement Form"},"content":{"rendered":"\n<div class=\"row align-center\"  id=\"row-2043610213\">\n\n\n\t<div id=\"col-871013145\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\n\n  <div class=\"banner has-hover\" id=\"banner-815021064\">\n          <div class=\"banner-inner fill\">\n        <div class=\"banner-bg fill\" >\n                                                \n                    <\/div>\n\t\t\n        <div class=\"banner-layers container\">\n            <div class=\"fill banner-link\"><\/div>            \n\n   <div id=\"text-box-189183045\" class=\"text-box banner-layer x50 md-x50 lg-x50 y50 md-y50 lg-y50 res-text\">\n                                <div class=\"text-box-content text dark\">\n              \n              <div class=\"text-inner text-center\">\n                  \n\n\t<div id=\"text-3661098888\" class=\"text\">\n\t\t\n\n<p><span style=\"font-size: 120%;\">This form is for travelers who are directly employed by the UW.\u00a0<\/span><\/p>\n<p>Regional\u00a0<span style=\"font-size: 100%;\">Travelers should complete the <a href=\"https:\/\/familymedicine.uw.edu\/network\/events\/travel-reimbursement\/non-uw-regional-traveler-reimbursement-form\/\">non-employee travel claim form<\/a> at this time.<\/span><\/p>\n\t\t\n<style>\n#text-3661098888 {\n  color: rgb(255,255,255);\n}\n#text-3661098888 > * {\n  color: rgb(255,255,255);\n}\n<\/style>\n\t<\/div>\n\t\n\n              <\/div>\n           <\/div>\n                            \n<style>\n#text-box-189183045 {\n  width: 60%;\n}\n#text-box-189183045 .text-box-content {\n  font-size: 100%;\n}\n<\/style>\n    <\/div>\n \n\n        <\/div>\n      <\/div>\n\n            \n<style>\n#banner-815021064 {\n  padding-top: 16%;\n}\n<\/style>\n  <\/div>\n\n\n<p>\u00a0<\/p>\n<p>Itemized receipts are required for all of the following:<\/p>\n<ul>\n<li>Air travel<\/li>\n<li>Lodging<\/li>\n<li>Car rentals (final agreement)<\/li>\n<li>Ride shares and taxis<\/li>\n<li>Other expenses over $75<\/li>\n<\/ul>\n<p>Receipts for other expenses under $75 do not need to be included.<\/p>\n<p><span style=\"font-size: 100%;\">Questions should be directed to <a href=\"mailto:fmrntravel@uw.edu\">fmrntravel@uw.edu<\/a>.<\/span><\/p>\n<div class=\"is-divider divider clearfix\" ><\/div>\n\n\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\n<style>\n#row-2043610213 > .col > .col-inner {\n  padding: 30px 30px 30px 30;\n}\n<\/style>\n<\/div>\n<div class=\"row\"  id=\"row-1573616097\">\n\n\n\t<div id=\"col-2062898091\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-22300 forminator-design--default  forminator_ajax draft-enabled\" data-forminator-render=\"0\" data-form=\"forminator-module-22300\" data-uid=\"6ab9314e7d9ee\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-22300\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-22300 forminator-design--default  forminator_ajax draft-enabled\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"22300\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\tenctype=\"multipart\/form-data\"\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"6ab9314e7d9ee\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Traveler Information<\/h2><hr class=\"forminator-border\" style=\"border: px solid #000000;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6ab9314e7d9ee\" id=\"forminator-field-text-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Traveler Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6ab9314e7d9ee\" id=\"forminator-field-email-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6ab9314e7d9ee\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6ab9314e7d9ee-label\" aria-describedby=\"forminator-radiogroup-6ab9314e7d9ee-description\"><span id=\"forminator-radiogroup-6ab9314e7d9ee-label\" class=\"forminator-label\">Mailing Address<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6ab9314e7d9ee\" class=\"forminator-radio\" title=\"I have logged into the UW Workday system and confirmed\/updated my home address.\"><input type=\"radio\" name=\"radio-3\" value=\"workday\" id=\"forminator-field-radio-3-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6ab9314e7d9ee-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">I have logged into the UW Workday system and confirmed\/updated my home address.<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6ab9314e7d9ee\" class=\"forminator-radio\" title=\"I have emailed the UW DFM Clinical Faculty Coordinator (cfcoord@uw.edu) to update my home address.\"><input type=\"radio\" name=\"radio-3\" value=\"emailed-dfm\" id=\"forminator-field-radio-3-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6ab9314e7d9ee-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">I have emailed the UW DFM Clinical Faculty Coordinator (cfcoord@uw.edu) to update my home address.<\/span><\/label><label id=\"forminator-field-radio-3-label-3\" for=\"forminator-field-radio-3-3-6ab9314e7d9ee\" class=\"forminator-radio\" title=\"I need help and will email fmrntravel@uw.edu now.\"><input type=\"radio\" name=\"radio-3\" value=\"need-help\" id=\"forminator-field-radio-3-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-3-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6ab9314e7d9ee-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">I need help and will email fmrntravel@uw.edu now.<\/span><\/label><span id=\"forminator-radiogroup-6ab9314e7d9ee-description\" class=\"forminator-description\">Reimbursement checks will be sent to the home address noted in the UW Workday system. To ensure your check is sent to the correct address, please confirm one of the following:<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6ab9314e7d9ee\" id=\"forminator-field-textarea-7_6ab9314e7d9ee-label\" class=\"forminator-label\">Address for Check<\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" aria-describedby=\"forminator-field-textarea-7_6ab9314e7d9ee-description\" ><\/textarea><span id=\"forminator-field-textarea-7_6ab9314e7d9ee-description\" class=\"forminator-description\">Address will be visible to all UW employees with access to the online reimbursement site.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Trip Information<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6ab9314e7d9ee-label\"><span id=\"forminator-radiogroup-6ab9314e7d9ee-label\" class=\"forminator-label\">Trip Purpose <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6ab9314e7d9ee\" class=\"forminator-radio forminator-radio-inline\" title=\"Conference\"><input type=\"radio\" name=\"radio-2\" value=\"Conference\" id=\"forminator-field-radio-2-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Conference<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6ab9314e7d9ee\" class=\"forminator-radio forminator-radio-inline\" title=\"Fellowship\"><input type=\"radio\" name=\"radio-2\" value=\"Fellowship\" id=\"forminator-field-radio-2-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Fellowship<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6ab9314e7d9ee\" class=\"forminator-radio forminator-radio-inline\" title=\"Certificate Program\"><input type=\"radio\" name=\"radio-2\" value=\"Certificate Program\" id=\"forminator-field-radio-2-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Certificate Program<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-6ab9314e7d9ee\" class=\"forminator-radio forminator-radio-inline\" title=\"Other\"><input type=\"radio\" name=\"radio-2\" value=\"Other\" id=\"forminator-field-radio-2-4-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-2-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6ab9314e7d9ee\" id=\"forminator-field-text-20_6ab9314e7d9ee-label\" class=\"forminator-label\">Event Name<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6ab9314e7d9ee\" id=\"forminator-field-text-2_6ab9314e7d9ee-label\" class=\"forminator-label\">Event Location<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6ab9314e7d9ee\" id=\"forminator-field-date-1-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Departure Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6ab9314e7d9ee\" id=\"forminator-field-text-16_6ab9314e7d9ee-label\" class=\"forminator-label\">Departure Time<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"10:00am\" id=\"forminator-field-text-16_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6ab9314e7d9ee\" id=\"forminator-field-date-2-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Return Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-2-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"\" id=\"forminator-field-date-2-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6ab9314e7d9ee\" id=\"forminator-field-text-18_6ab9314e7d9ee-label\" class=\"forminator-label\">Return Time<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"10:00am\" id=\"forminator-field-text-18_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Expenses for Personal Reimbursement<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p>Itemized receipts are not required except for airfare, lodging, car rentals (final agreement), ride shares and taxis, and expenses over $75.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6ab9314e7d9ee\" id=\"forminator-field-textarea-2_6ab9314e7d9ee-label\" class=\"forminator-label\">Travel Summary<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" aria-describedby=\"forminator-field-textarea-2_6ab9314e7d9ee-description\" ><\/textarea><span id=\"forminator-field-textarea-2_6ab9314e7d9ee-description\" class=\"forminator-description\">To ensure all travel-related expenses are covered, please briefly describe how you traveled to your destination and include all modes of transportation (e.g. ground transportation\/mileage between home and airport, etc.).<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><p><h3>Airfare<\/h3><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_6ab9314e7d9ee\" id=\"forminator-field-currency-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Airfare<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-1_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"upload-4\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-4_6ab9314e7d9ee\" id=\"forminator-field-upload-4_6ab9314e7d9ee-label\" class=\"forminator-label\">Itinerary &amp; Itemized Receipts <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload \" data-element=\"upload-4_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-4_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-4[]\" id=\"forminator-field-upload-4_6ab9314e7d9ee\" class=\"forminator-input-file-required do-validate forminator-field-upload-4_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-4_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-4_6ab9314e7d9ee-description\" class=\"forminator-description\">Include the comparison airfare if personal time is included. Receipts must be itemized.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-4_6ab9314e7d9ee\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><h3>Baggage Fees<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-10\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-10-picker_6ab9314e7d9ee\" id=\"forminator-field-date-10-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date 1<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-10-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-10\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-10-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"currency-12\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-12_6ab9314e7d9ee\" id=\"forminator-field-currency-12_6ab9314e7d9ee-label\" class=\"forminator-label\">Baggage Fee 1<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-12\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-12_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-11\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-11-picker_6ab9314e7d9ee\" id=\"forminator-field-date-11-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date 2<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-11-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-11\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-11-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"currency-13\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-13_6ab9314e7d9ee\" id=\"forminator-field-currency-13_6ab9314e7d9ee-label\" class=\"forminator-label\">Baggage Fee 2<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-13\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-13_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-12\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-12_6ab9314e7d9ee\" id=\"forminator-field-upload-12_6ab9314e7d9ee-label\" class=\"forminator-label\">Itemized Baggage Receipts <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload \" data-element=\"upload-12_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-12_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-12[]\" id=\"forminator-field-upload-12_6ab9314e7d9ee\" class=\"forminator-input-file-required do-validate forminator-field-upload-12_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-12_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-12_6ab9314e7d9ee-description\" class=\"forminator-description\">Required for expenses exceeding $75 (please include itemized receipts).<\/span><ul class=\"forminator-uploaded-files upload-container-upload-12_6ab9314e7d9ee\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><h3>Ground Transportation<\/h3>\n<p>As of 9\/1\/24, receipts are required for all ride shares and taxis.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-12\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-12-picker_6ab9314e7d9ee\" id=\"forminator-field-date-12-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-12-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-12\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-12-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-1_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-1_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-1_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-14\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-14_6ab9314e7d9ee\" id=\"forminator-field-currency-14_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-14\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-14_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6ab9314e7d9ee\" id=\"forminator-field-text-21_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-13\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-13-picker_6ab9314e7d9ee\" id=\"forminator-field-date-13-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-13-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-13\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-13-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-2_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-2_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-2_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-2_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-15\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-15_6ab9314e7d9ee\" id=\"forminator-field-currency-15_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-15\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-15_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6ab9314e7d9ee\" id=\"forminator-field-text-22_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-14\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-14-picker_6ab9314e7d9ee\" id=\"forminator-field-date-14-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-14-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-14\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-14-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-3_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-3_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-3_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-3_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-16\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-16_6ab9314e7d9ee\" id=\"forminator-field-currency-16_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-16\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-16_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6ab9314e7d9ee\" id=\"forminator-field-text-23_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-15\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-15-picker_6ab9314e7d9ee\" id=\"forminator-field-date-15-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-15-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-15\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-15-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-4_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-4_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-4_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-4_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-17\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-17_6ab9314e7d9ee\" id=\"forminator-field-currency-17_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-17\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-17_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_6ab9314e7d9ee\" id=\"forminator-field-text-24_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-16\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-16-picker_6ab9314e7d9ee\" id=\"forminator-field-date-16-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-16-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-16\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-16-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-5_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-5_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-5_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-5_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-18\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-18_6ab9314e7d9ee\" id=\"forminator-field-currency-18_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-18\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-18_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-25\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-25_6ab9314e7d9ee\" id=\"forminator-field-text-25_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-25\" value=\"\" placeholder=\"\" id=\"forminator-field-text-25_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-17\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-17-picker_6ab9314e7d9ee\" id=\"forminator-field-date-17-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-17-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-17\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-17-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-6_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-6_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-6_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-6_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-19\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-19_6ab9314e7d9ee\" id=\"forminator-field-currency-19_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-19\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-19_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-26\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-26_6ab9314e7d9ee\" id=\"forminator-field-text-26_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-26\" value=\"\" placeholder=\"\" id=\"forminator-field-text-26_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-18\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-18-picker_6ab9314e7d9ee\" id=\"forminator-field-date-18-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-18-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-18\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-18-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-7_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-7_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-7_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-7\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-7_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-20\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-20_6ab9314e7d9ee\" id=\"forminator-field-currency-20_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-20\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-20_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-27\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-27_6ab9314e7d9ee\" id=\"forminator-field-text-27_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-27\" value=\"\" placeholder=\"\" id=\"forminator-field-text-27_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-19\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-19-picker_6ab9314e7d9ee\" id=\"forminator-field-date-19-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-19-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-19\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-19-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-8_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-8_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-8_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-8_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-21\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-21_6ab9314e7d9ee\" id=\"forminator-field-currency-21_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-21\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-21_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-28\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-28_6ab9314e7d9ee\" id=\"forminator-field-text-28_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-28\" value=\"\" placeholder=\"\" id=\"forminator-field-text-28_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-20\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-20-picker_6ab9314e7d9ee\" id=\"forminator-field-date-20-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-20-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-20\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-20-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-22300__field--select-9_6ab9314e7d9ee\" id=\"forminator-form-22300__field--select-9_6ab9314e7d9ee-label\" class=\"forminator-label\">Expense Type<\/label><select  id=\"forminator-form-22300__field--select-9_6ab9314e7d9ee\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"--\" data-search=\"false\" data-search-placeholder=\"--\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-22300__field--select-9_6ab9314e7d9ee-label\"><option value=\"\"  >--<\/option><option value=\"one\"  data-calculation=\"0\">Parking<\/option><option value=\"two\"  data-calculation=\"0\">Tolls<\/option><option value=\"three\"  data-calculation=\"0\">Bus &amp; Light Rail<\/option><option value=\"four\"  data-calculation=\"0\">Shuttle<\/option><option value=\"five\"  data-calculation=\"0\">Taxi<\/option><option value=\"six\"  data-calculation=\"0\">Car Rental<\/option><option value=\"seven\"  data-calculation=\"0\">Car Rental Gas<\/option><option value=\"eight\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"currency-22\" class=\"forminator-field-currency forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-22_6ab9314e7d9ee\" id=\"forminator-field-currency-22_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-22\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-22_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"text-29\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-29_6ab9314e7d9ee\" id=\"forminator-field-text-29_6ab9314e7d9ee-label\" class=\"forminator-label\">Business Purpose<\/label><input type=\"text\" name=\"text-29\" value=\"\" placeholder=\"\" id=\"forminator-field-text-29_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_6ab9314e7d9ee\" id=\"forminator-field-upload-2_6ab9314e7d9ee-label\" class=\"forminator-label\">Car Rental Final Agreement<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-2_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-2_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-2[]\" id=\"forminator-field-upload-2_6ab9314e7d9ee\" class=\"forminator-input-file forminator-field-upload-2_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-2_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-2_6ab9314e7d9ee-description\" class=\"forminator-description\">Required for car rental reimbursement (must include the driver's name) and included itemized expenses.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-2_6ab9314e7d9ee\"><\/ul><\/div><\/div><div id=\"upload-3\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-3_6ab9314e7d9ee\" id=\"forminator-field-upload-3_6ab9314e7d9ee-label\" class=\"forminator-label\">Itemized Receipts<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-3_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-3_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-3[]\" id=\"forminator-field-upload-3_6ab9314e7d9ee\" class=\"forminator-input-file forminator-field-upload-3_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-3_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-3_6ab9314e7d9ee-description\" class=\"forminator-description\">Please include itemized receipts for ride shares, taxis, and expenses exceeding $75.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-3_6ab9314e7d9ee\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><h3>Lodging<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_6ab9314e7d9ee\" id=\"forminator-field-currency-2_6ab9314e7d9ee-label\" class=\"forminator-label\">Lodging<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"$\" id=\"forminator-field-currency-2_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6ab9314e7d9ee\" id=\"forminator-field-upload-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Itemized Lodging Receipt <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-1_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_6ab9314e7d9ee\" class=\"forminator-input-file-required do-validate forminator-field-upload-1_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-1_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-1_6ab9314e7d9ee-description\" class=\"forminator-description\">Required for lodging reimbursement.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-1_6ab9314e7d9ee\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-8\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-8\"><h3>Miscellaneous Expenses<\/h3>\n<p>Expenses must be related to <a href=\"https:\/\/finance.uw.edu\/travel\/miscexpenses\">UW business purposes<\/a> such as flight Wi-Fi fees and conference registrations (please note if conference registration should come out of DFM allotted CME funds).<\/p>\n<p>Receipts must be provided for expenses over $75.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-30\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-30_6ab9314e7d9ee\" id=\"forminator-field-text-30_6ab9314e7d9ee-label\" class=\"forminator-label\">Description &amp; Business Purpose<\/label><input type=\"text\" name=\"text-30\" value=\"\" placeholder=\"\" id=\"forminator-field-text-30_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-23\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-23_6ab9314e7d9ee\" id=\"forminator-field-currency-23_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-23\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-23_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-31\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-31_6ab9314e7d9ee\" id=\"forminator-field-text-31_6ab9314e7d9ee-label\" class=\"forminator-label\">Description &amp; Business Purpose<\/label><input type=\"text\" name=\"text-31\" value=\"\" placeholder=\"\" id=\"forminator-field-text-31_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-24\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-24_6ab9314e7d9ee\" id=\"forminator-field-currency-24_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-24\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-24_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-32\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-32_6ab9314e7d9ee\" id=\"forminator-field-text-32_6ab9314e7d9ee-label\" class=\"forminator-label\">Description &amp; Business Purpose<\/label><input type=\"text\" name=\"text-32\" value=\"\" placeholder=\"\" id=\"forminator-field-text-32_6ab9314e7d9ee\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-25\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-25_6ab9314e7d9ee\" id=\"forminator-field-currency-25_6ab9314e7d9ee-label\" class=\"forminator-label\">Amount<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-25\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-25_6ab9314e7d9ee\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-13\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-13_6ab9314e7d9ee\" id=\"forminator-field-upload-13_6ab9314e7d9ee-label\" class=\"forminator-label\">Itemized Receipts<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-13_6ab9314e7d9ee\" aria-describedby=\"forminator-field-upload-13_6ab9314e7d9ee-description\"><input type=\"file\" name=\"upload-13[]\" id=\"forminator-field-upload-13_6ab9314e7d9ee\" class=\"forminator-input-file forminator-field-upload-13_6ab9314e7d9ee-22300\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-13_6ab9314e7d9ee\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-13_6ab9314e7d9ee-description\" class=\"forminator-description\">Please include itemized receipts for miscellaneous expenses exceeding $75.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-13_6ab9314e7d9ee\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Meals<\/h2><hr class=\"forminator-border\" style=\"border: px solid #000000;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6ab9314e7d9ee-label\"><span id=\"forminator-radiogroup-6ab9314e7d9ee-label\" class=\"forminator-label\">Were any meals provided by others (conference, hotel, attendees, etc.?)<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6ab9314e7d9ee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"Yes\" id=\"forminator-field-radio-1-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6ab9314e7d9ee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"No\" id=\"forminator-field-radio-1-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6ab9314e7d9ee\" id=\"forminator-field-textarea-5_6ab9314e7d9ee-label\" class=\"forminator-label\">Please describe meals provided (date, meal type (breakfast, etc.))<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6ab9314e7d9ee\" id=\"forminator-field-date-3-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-3-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-3-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-1-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-1-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-1-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-1-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-1-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-1-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Dinner\" id=\"forminator-field-checkbox-1-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-1-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6ab9314e7d9ee\" id=\"forminator-field-date-4-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-4-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-4-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-2-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-2-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-2-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-2-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-2-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-2-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Dinner\" id=\"forminator-field-checkbox-2-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-2-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_6ab9314e7d9ee\" id=\"forminator-field-date-5-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-5-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-5-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-3-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-3-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-3-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-3-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-3-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-3-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Dinner\" id=\"forminator-field-checkbox-3-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-3-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_6ab9314e7d9ee\" id=\"forminator-field-date-6-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-6-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-6-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-4-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-4-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-4-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-4-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-4-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-4-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Dinner\" id=\"forminator-field-checkbox-4-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-4-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_6ab9314e7d9ee\" id=\"forminator-field-date-7-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-7-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-7-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-5-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-5-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-5-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-5-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-5-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-5-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-5-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Dinner\" id=\"forminator-field-checkbox-5-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-5-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_6ab9314e7d9ee\" id=\"forminator-field-date-8-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-8-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-8-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-6-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-6-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-6-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-6-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-6-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-6-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-6-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Dinner\" id=\"forminator-field-checkbox-6-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-6-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-9\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-picker_6ab9314e7d9ee\" id=\"forminator-field-date-9-picker_6ab9314e7d9ee-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-9-picker_6ab9314e7d9ee\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-9\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-9-picker_6ab9314e7d9ee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6ab9314e7d9ee-label\"><span id=\"forminator-checkbox-group-6ab9314e7d9ee-label\" class=\"forminator-label\">Per Diem Requested For:<\/span><label id=\"forminator-field-checkbox-7-1-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-7-1-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Breakfast\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-7-1-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breakfast<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-7-2-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Lunch\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"two\" id=\"forminator-field-checkbox-7-2-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-7-2-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lunch<\/span><\/label><label id=\"forminator-field-checkbox-7-3-6ab9314e7d9ee-label\" for=\"forminator-field-checkbox-7-3-6ab9314e7d9ee\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Dinner\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Dinner\" id=\"forminator-field-checkbox-7-3-6ab9314e7d9ee\" aria-labelledby=\"forminator-field-checkbox-7-3-6ab9314e7d9ee-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dinner<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Privately-owned Vehicle Mileage<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><ul>\n<li>\n<p>If you are driving instead flying, you will be reimbursed for your mileage at the current rate $0.76\/mile (effective 7\/1\/2026) up to the lowest cost of the roundtrip airfare quote if driving from the office.<\/p>\n<\/li>\n<li>\n<p>Mileage is usually calculated based the shortest distance from your business address to the destination. On non-regular work days, mileage can be calculated based on your residence.<\/p>\n<\/li>\n<li>\n<p>Mileage to the airport is available for reimbursement (round trip mileage reimbursement if a third party drives - eg. family member takes you to airport). Please note third party drivers in the comments box.<\/p>\n<\/li>\n<li>\n<p>Google Maps will be used by the Network office to calculate and verify final mileage.<\/p>\n<\/li>\n<\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6ab9314e7d9ee\" id=\"forminator-field-textarea-3_6ab9314e7d9ee-label\" class=\"forminator-label\">Address of Departure Point:<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6ab9314e7d9ee\" id=\"forminator-field-textarea-4_6ab9314e7d9ee-label\" class=\"forminator-label\">Address of Destination:<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Review &amp; Submit<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6ab9314e7d9ee\" id=\"forminator-field-textarea-6_6ab9314e7d9ee-label\" class=\"forminator-label\">Additional Comments<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6ab9314e7d9ee\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6ab9314e7d9ee\" id=\"forminator-field-consent-1_6ab9314e7d9ee-label\" class=\"forminator-label\">Acceptance of Network Travel Policies <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label for=\"forminator-field-consent-1_6ab9314e7d9ee\" id=\"forminator-field-consent-1_6ab9314e7d9ee__label\" class=\"forminator-checkbox forminator-consent\" style=\"margin: 0;\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6ab9314e7d9ee\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6ab9314e7d9ee-label\" aria-describedby=\"forminator-field-consent-1_6ab9314e7d9ee__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6ab9314e7d9ee__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Completion and submission of this form indicates your knowledge and acceptance of our <a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/familymedicine.uw.edu\/network\/events\/travel-reimbursement\/\">travel policies<\/a>.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Le5gEUrAAAAABNgHfl41h_LFA1YeHUZ4vm95oo9\" data-size=\"invisible\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><a href=\"#\" class=\"forminator-save-draft-link disabled\" title=\"Fill in form fields before saving it as a draft\" formnovalidate>Save as Draft<\/a><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"303ff4ed39\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/network\/wp-json\/wp\/v2\/pages\/21564\" \/><input type=\"hidden\" name=\"form_id\" value=\"22300\"><input type=\"hidden\" name=\"page_id\" value=\"21564\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/familymedicine.uw.edu\/network\/events\/travel-reimbursement\/general\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"save_draft\" value=\"false\"><\/form>\n\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n<\/div>\n\n\n<meta name=\"description\" content=\"Travel reimbursement form for UW-employed travelers on FMRN business\" 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