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Currency [0]/Explanatory TextG5Explanatory Text %0 : Followed Hyperlink 1Good;Good  a%2 Heading 1G Heading 1 I}%O3 Heading 2G Heading 2 I}%?4 Heading 3G Heading 3 I}%235 Heading 49 Heading 4 I}%6( Hyperlink 7InputuInput ̙ ??v% 8 Linked CellK Linked Cell }% 9NeutralANeutral  e%"Normal :Noteb Note   ;OutputwOutput  ???%????????? ???<$Percent =Title1Title I}% >TotalMTotal %OO? Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight16`aSheet1Sheet25Sheet3  ;Y1ZR3  @@  [U5INDIVIDUAL EVENT ATTENDANCE REQUEST FOR REIMBURSEMENT"Wisconsin RTAP Scholarship Program&Wisconsin Department of Transportation Expenditures Out-of-StateDateDeparture Time Return TimePers. Veh. MilesAmountLunchDinner BreakfastMealsTotal ExpensesTotal Personal Vehicle MilesTotals CERTIFICATIONMILEAGE CALCULATION=Pers. Veh. Miles X Rate:ExpensesMileage Travel TotalReimb. %Total ReimbursementAPPROVALLodging1Out-of-state - Contact RTAP Coordinator for ratesiReceipts are required for Registration Fees/Tuition, Parking, Lodging, Airfare and Ground Transportation.Agency/OrganizationAttendee Name (First and Last)2Mailing Address (Street or PO Box, City, ZIP Code)Name of Event AttendedOfficial/OfficerAttendee Position TitleAttendee E-mail Address Event Date(s)Event Location (City, State)'Submit completed application forms via: U.S. MailFAXRTAP Coordinator3Bureau of Transit, Local Roads, Railroads & Harbors PO Box 7913Madison, WI 53707-7913Attention RTAP Coordinator(608) 266-0658,If you FAX your documents, DO NOT mail them.TOTALS & REIMBURSEMENTKDescription/Explanation (Registration Fee, Lodging, Airfare, Parking, etc.)BClaim the lessor of airfare plus ground transportation OR mileage.  79 I certify that the claimant attended the event identified above. I have reviewed this expense claim and find it to be reasonable and in compliance with the established RTAP Scholarship guidelines.REIMBURSEMENT PERCENTAGES In-state:All other in-state events - 80% Out-of-state:All events - 70%%Conference/Training Evaluation ReportzWould you recommend attendance at this program in the future for other persons involved in rural passenger transportation?qBriefly describe why you would or would not recommend attendance at this program in the future for other persons.LHow would you rate this event in terms of substantive information presented?qHow would you rate the program as an opportunity to meet and communicate with your peers in the transit industry? Excellent Very GoodNeutralNot GoodTerribleReimbursement requests must be received by WisDOT within 60 days following an event. Reimbursement requests received later than that are subject to denial of reimbursement. Reimbursement for requests submitted without all the required receipts and documentation will be delayed until all required documentation is received by WisDOT. Reimbursement checks will be payable and mailed to the organization registered as a vendor with WisDOT.@ Allowable rates for RTAP scholarships are the same as State rates and are subject to change without notice when the State rates are adjusted. Contact the RTAP coordinator for current hotel rate allowances for specific out-of-state cities.Event Sponsor (If Applicable)I certify that the expenses itemized were incurred as part of my attendance at and participation in the event identified above.(Approver Signature)(Claimant Signature)(Date)To use this electronic fill-in form, place your cursor in the first fill-in blank (the Agency/Organization field). Use the tab key to move from one field to the next. Use the mouse to fill in check boxes. Math calculations will be performed automatically.Sarah Probasco (608) 264-8426sarah.probasco@dot.wi.govHIn-state - $70/night; $80/night in Milwaukee, Racine & Waukesha countiesWRAPP Roadeo, CTED Training Sessions, WisDOT-sponsored Mobility Manager Workshops, WRAPP/WURTA Fall Conference and in-state events totalling $100 or less - 100%E-mail (preferred)Upon completion of data entry, save the form to your computer. Print the completed document(s), obtain the required handwritten signatures and FAX or mail to WisDOT's RTAP coordinator. Include applicable receipts, event agenda, and a copy of the application reward letter.&Questions or problems? 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