Section A

Please fill out this section entirely. Include specific days of the week, times, and dates:

For example:

Saturdays, 8:00-10:30 a.m.
September 6, September 20, October 4, October 18, November 1, November 15, November 29

Section B

  • List specific mileage from home to location (one direction only). Attach MapQuest.
  • List specific mileage from Indiana campus to location (one direction only) as follows:
    • Distance from IUP to CCAC: 40.6 miles
    • Distance from IUP to Monroeville: 43.9 miles
  • List the number of trips to location (consistent with those listed in Section A above).
  • List the number of trips from location (consistent with those listed in Section A above).
  • Take the mileage of the shortest trip (from home or from campus), multiply it by 2 (there and back), and multiply that by the number of trips to get the Total Miles Traveled.
  • Select whether you would like to be paid in cash or if you want funds to be posted to your university professional development account.

Section C

You do not have to do anything in this section. Assistant Dean Strittmatter will fill this out for you.

Section D

Please sign and date.