Date:
Nebraska Department of Transportation and Nebraska Association of Transportation Providers Out-of-State Travel Application (5311 Subrecipients)
Select one of the following: Request approval for NATP scholarship to be reimbursed with 100% NATP funds. Request approval for RTAP scholarship to be reimbursed with 100% Federal RTAP funds. Request approval for reimbursement at 80% Federal Section 5311 funds and 10% State funds.
Describe why you want to attend this out-of-state event. What knowledge will you gain? How will attendance assist you in performing your transit duties, etc.?
Meeting:
Place:	Dates of Travel:
Purpose:
To Be Attended By:
Transit Agency:
Employee Name(s) Requesting Approval:
Estimated Expenses:
Travel:	Amount
Originating City:	Final Destination:	Carrier(s):
Cost Per Ticket: $ (# of Employees)	$	0.00
Personal Vehicle Mileage: miles @ $0.655 per mile	$	0.00
Lodging:
Cost Per Day: $ (# of Days)	$	0.00
$ (# of Days)	$	0.00
Meals:
Cost Per Day: $ (# of Days)	$	0.00
$ (# of Days)	$	0.00
Miscellaneous: (taxi, parking, etc.)
Amount: $	$	0.00
Amount: $	$	0.00
Amount: $	$	0.00
Total Travel Expense	$	0.00
Conference Registration:
Cost Per Person: $ (# of Employees)	$	0.00

Total Cost of Trip	$	0.00

Do you agree to attend the annual transit managers’ workshop and share information about your experience attending this event? (Barring unforeseen circumstances) Yes No If requested, do you agree to provide written information about your experience attending this event? Yes No
Please list all out-of-state transit-related events attended in the prior 18 months:
Event
100% RTAP Funds 100% NATP Funds 90% 5311 and State Funds
100% RTAP Funds 100% NATP Funds 90% 5311 and State Funds
100% RTAP Funds 100% NATP Funds 90% 5311 and State Funds

After completion of this form, submit to Sarah Soula, NDOT, at sarah.soula@nebraska.gov and Jennifer Eurek, NATP, at jennifer@youraam.com

For NDOT and NATP Use Only
Reviewed and Approved By:
Name:	Title:	Signature:
Reviewed and Declined By:
Name:	Title:	Signature:

Remarks: