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Per Diem Form- In-State Travel

Please complete the form below. Required fields marked with an asterisk *

Form #2


This form must be turned in by the first Friday of the month of travel in order to receive per diem money prior to depature. 

Per Diem for meals is to cover the difference it would have cost to eat out vs. eating at home; not to cover your entire meal.

WCSD #1 cannot reimburse for meals furnished as part of registration/conference/continental breakfast  fees.

For In-State Travel & Surrounding Area (80 mile radius from Newcastle):

Travel Details:

Leaving from Newcastle:

Departure Date Meals*
Note: mark lunch and supper if leaving before 11:00 AM, mark supper only if leaving between 11:00 AM and 4:00 PM
Answer Required

Number of days in between leaving and returning:

Breakfast ($7.00)*
Answer Required
Lunch ($9.00)*
Answer Required
Supper ($15.00)*
Answer Required

Returning to Newcastle:

Return Date Meals*
Note: mark breakfast if returning after 8:00 AM, mark breakfast and lunch if returning after 2:00 PM, and mark lunch and supper if returning after 7:00 PM
Answer Required
Employee Signature*
[Insert Digital Signature File below]
Answer Required
or drag it here.