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Home » About UPMC Hillman Cancer Center » Policies and Forms » Hillman Travel Request Form

Hillman Travel Request Form

Use this form for:

All international travel.
Any travel within the United States for which you may be requesting Hillman funds to cover all or a portion of the expenses. Hillman funds include all funds other than grants, contracts and sponsored programs. They include hard funds, restricted funds (including Hillman Foundation funds, which cannot be used for travel), discretionary funds, start-up packages, and other Hillman commitments of support.
The Office of the Director of Hillman has the responsibility to approve all expenses from Hillman funds. The Office of the Director of Hillman also reserves the right to disapprove inappropriate or excessive use of funds from all other sources, including excessive travel without acceptable justification.

Please provide at least 10 business days notice to process this request.

Prior to completing this form, please review the Hillman Travel & Business Expense Reimbursement Policy (Revised).

Instructions for Completing and Submitting Form

Submit the completed form and supporting documentation as follows:

1. Online Submission of Form:

Complete Sections I-IV and submit form. Note: For Supporting Documentation in Section IV, you will be asked to provide URLs for the conference web page, and meeting brochure or flyer. If there is no online information available, you will need to submit scanned or hard copies of conference information (see Item 2 below).
After submitting form electronically, you will receive a PDF of your completed form. Save this file to your computer. You may need the PDF to submit with hard copies of your supporting documentation.

2. Submission of Supporting Documentation: Please submit supporting documentation using one of the following methods:

Online Form (preferred): In Section IV of the online form below, provide URLs for the conference web page, and/or meeting brochure or flyer.

-Or-

E-mail submission: If you have only hard copies of the supporting documentation for the conference/meeting, please scan the information and e-mail the .pdf of your completed form and all scanned documents as attachments to:
Alison Lithgow at lithgowap@upmc.edu
Subject line: Travel Request for [your name]

-Or-

Hard copy submission: If supporting documentation is available only as hard copy and you are unable to scan, please print your completed form (the .pdf document), attach a hard copy of supporting documentation, and send/deliver all pages to:

Alison Lithgow
UPMC Cancer Pavilion
4th Floor, Room 445
5150 Centre Avenue
Pittsburgh, PA 15232

CAPTCHA
I. General Information
First Name*
Last Name*
Email*
Phone*
PI of Laboratory you are affiliated with*
if applicable
II. Travel/Conference Details
Name of person traveling*
Date of Departure*
Date Format: MM slash DD slash YYYY
Date of Return*
Date Format: MM slash DD slash YYYY
Reason for travel*
Conference name*
Conference location*
City/State/Country
Conference/Meeting Start Date*
Date Format: MM slash DD slash YYYY
Conference/Meeting End Date*
Date Format: MM slash DD slash YYYY
Estimated costs
Hotel ($)
Registration ($)
Travel($)
airfare, mileage, car rental, etc.
Meals/Per Diem ($)
Other ($)
Other Description
III. Funding Source
Available sources of funding (Please provide complete information for all lines that apply):
Grant Funds: You may select up to three grant funds
Grant 1
- Yes
- No
Grant 1 Account #*
$ Amount or % of Funds*
Grant 2
- Yes
- No
Grant 2 Account #*
$ Amount or % of Funds*
Grant 3
- Yes
- No
Grant 3 Account #*
$ Amount or % of Funds*
Hillman Funds*
Start-up/Other Hillman Commitments
- Yes
- No
Start-up/Other Account #*
$ Amount or % of Funds*
Discretionary Funds
- Yes
- No
Discretionary Account #*
$ Amount or % of Funds*
Restricted Funds
- Yes
- No
Restricted Funds
- Yes
- No
Restricted Account #*
$ Amount or % of Funds*
*Notes:
- Hillman Foundation funds cannot be used for travel.
- The Office of the Director of Hillman has the responsibility to approve all expenses from Hillman funds. The Office of the Director of Hillman also reserves the right to disapprove inappropriate or excessive use of funds from all other sources, including excessive travel without acceptable justification.
IV. Supporting Documentation
Please provide URLs for the conference web page, and/or meeting brochure or flyer. If there is no online information available, you will need to submit scanned or hard copies of conference information as described in the instructions.
URLs for conference/meeting information
V. Approvials (NOT to be completed by applicant)
1. Fiscal Office Verification of Funds
Approval
- Yes
- No
Name
Date
Comments
2. Office of the Director of UPCI
Approval
- Yes
- No
Name
Date
Comments