Unscheduled Events Request

Unscheduled Events Request Form

General Information

Name(Required)

First Last

Email(Required)

Business Purpose(Required)

Breif Description of Expenses and Their Purpose(Required)

Please provide a brief description of your expenses and their purpose. This should include what you paid for versus what was prepaid (e.g. with a lab P-Card). Please include enough detail to allow BMC staff to answer Who, What, Where, When, and Why when preparing your reimbursement.

Detailed Benefit for UW Madison in justification of this Event (Required by SMPH Fiscal).(Required)

Example: Dr. XXXX attended the 27th Annual Spring conference on XXXXXX in XXXX, April 12-15, 2023. This benefits the University of Wisconsin as Dr. XXX gained valuable information and tips regarding care of ill patients that she can apply to both her general pediatric and urgent care jobs, to improve patient Care. In particular, Dr. XXX learned more about caring for babies with fever and sepsis, how to differentiate different important rashes, how to identify significant injuries in baseball players and how to manage foreign bodies in different locations. There was also information and updates for the ongoing care of patients with mental health issues. This knowledge will be shared with faculty colleagues and students that Dr. XXXX teaches.

Event Start Date(Required)

Start Time

Event End Date(Required)

End Time

Funding Information(Required)

PLEASE PROVIDE THE PROJECT NUMBER(S) (format AAA1111) from which this reimbursement is to be paid. If expenses should be split, please indicate percentages or specific costs next to each project.

Meeting Room

Is a meeting room required?(Required)

Yes

What is the approximate number of attendees?

Please provide your top choices.

Travel

Is airfare required?(Required)

Yes

What city or state, and country is this individual traveling from?(Required)

Start Date

End Date

Hotel

Does a room need to be reserved?(Required)

Yes

Where should this room be reserved?

Start Date

End Date

Food

Are meals being provided?(Required)

Yes

Please list dates and meals (breakfast, lunch, dinner, appetizers, etc.)

Notes

Useful Documents Upload

Drop files here or

Max. file size: 24 MB.

Please attach only documents here. You may scan receipts or take pictures with a smartphone or other device, but please be sure the images are clear.

If you have any additional notes regarding the event and request described above, please add them here.

Comments

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