WINTHROP UNIVERSITY

DEPARTMENT OF SOCIAL WORK

LEGISLATIVE DAY TRAVEL REIMBURSEMENT FORM

Drivers are eligible for a $15 travel reimbursement if they transport three (3) or more Winthrop social work students in addition to the driver to Columbia for the Legislative Day.

Driver: _____________________________________________

Please Print

Planned Riders: _________________________________

Please Print

_________________________________

Please Print

_________________________________

Please Print

_________________________________

Please Print

Actual Riders: ___________________________ ________________________

Please Print Signature

___________________________ ________________________

Please Print Signature

___________________________ ________________________

Please Print Signature

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Please Print Signature

Claim for reimbursement:

I certify that I transported the Winthrop students who signed above to the Social Work Student Legislative Day in Columbia and am therefore eligible for a $15 reimbursement.

Driver: ________________________________ ________________________

Signature Date

________________________________

Social Security Number

Authorized: ________________________________ ________________________

Ronald K. Green, JD, ACSW Date

Chair