Hoosier Explorers Online Trip Reimbursement Form

Submit your reimbursement request after your trip.

Teacher Name ( First and Last)*
Teacher Email Address*
Grade*
Name of School*
School District*
School Phone Number (with area code)*
School Address to Mail Reimbursement Check To:*
School/District Name Attention to: Street City, State, & ZIP Code
Field Trip Destination (Must be within Indiana)*
Estimated number of students*
Date of Field Trip*
MM slash DD slash YYYY
Number of participating students*
Number of participating adults (teachers, chaperones)*
Cost of Drivers*
Number of Hours Worked x Hourly Wage = Driver Cost
Cost of Benefits*
FICA + Social Security = Driver Benefits
Cost of Fuel
Total Miles x Cost per Gallon of Fuel = Fuel Cost
Total Cost of Transportation*
Cost of Drivers + Cost of Benefits + Fuel Cost = Total Cost of Transportation
Upload Your File(s)
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB, Max. files: 10.
Pictures or Student Work Product Relating to Trip, Max 10 Files. (Permitted files types include, jpg, gif, png, pdf, doc, docx)
Name
This field is for validation purposes and should be left unchanged.