HomeMy WebLinkAboutOut of State Travel Request - New Hope DV/SAGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT:New Hope
REQUEST SUBMITTED BY: SuziFode
CONTACT PERSON ATTENDING ROUNDTABLE: SuziFode
CONFIDENTIAL INFORMATION: DYES R NO
DATE: 10.29.2024
PRONE.
11 1 ME ��l UMMI
i
1--U11111:4 � I
i I ;t 1
iumMir-111111"a
11 IN -1
99-
DAgreement / Contract
DAP Vouchers
-01
OAppointment / Reappointment
DARPA Related
0 Bids / RFPs / Quotes Award
013id Opening Scheduled
OBoards I Committees
0 Budget
OComputer Related
0 County Code
OEmergency Purchase
D Employee Rel.
OFacilities Related
ElFinancial
OFunds
0 Hearing
0 Invoices / Purchase Orders
17Grants — Fed/State/County
0 Leases
0 MOA / MOD
ElMinutes
ROrdinances
R Out of State Travel
D Petty Cash
El Policies
[]Proclamations
[]Request for Purchase
[]Resolution
0 Recommendation
OProfessional Serv/Consultant
DSupport Letter
DSurplus Req.
DTax Levies
[]Thank You's
E]Tax Title Property
EIWSLCB
-------------
9 La 2 LM 5 911 sul
Request to travel out of state for the San Diego International Conference on Child and Family Maltreatment
January 26-31, 2025. Employees include: Suzi Fode, Debbie Gonzalez -Long, Celina Garcia, Sara MacDonald,
Anthony Cortez, Elisa Adolphsen, Trisha Glenn & Laura Oronia. All costs covered by scholarship or grants.
--------------
Each staff request is a different amount depending on the grant/scholarship applicable to them. See attached.
If necessary, was this document reviewed by accounting? M YES F1 NO @9 N/A
If necessary, was this document reviewed by legal? 0 YES El NO R N/A
2 Ll
DATE OF ACTIONy �'` ` ,�45
-
APPROVE: DENIED ABSTAIN
D1:
D2:
D3-
4/23/24
DEFERRED OR CONTINUED TO:
WITHDRAWN:
OCT 21 2024
I GRANT COUNTY COMMISSIONIERS
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Nanie* Dept/Committee* Date of Request* Travel Tpe*
-----------
SuziFode New Hope 1
10/2 Out of State Travel Y -- 1 - 12024'
Departure Date* Return Date* Grant* Fund/Dept*
112612025 IE --
/2612025 1131/2026 Yes New Hope
05:00 AM 11 M.30 PM
Destination (City, County, State)* Purpose of Iravel*
San Diego, San Diego, CA 40rh Annual San Diego International Conference on
C 'lid and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
199 199 Government Rate V Yes ►
Hotel Total* Conference Fee* Daffy M&IE at Rental Car Cost per day*
..............
Destination*
1130 700 130
608.34
04% VMW 4% M-A
IWAY
E, xplanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
Alaska Air 300 3523.34
Preparer's Name*
Elisa Adolphsen
Preapproved by EOIDH?*
Yes
n
Preparer"s Tiltlo*
---- ------- ----------------
CAC Coordinator
Use of travel card to fill a rental vehicle gas tank prior
Wits return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Committee* Date of Request* Travel Type*
Debbie Gonzalez Long Now Hope 10/21/2202L4 Out of State Travel v
j
Departure Date* Return Date* Grant* Fund/Dept*
AWO
/26/202E5 1/31/2025 Yes New Hope
--I -
11-1 - I v - .J -
05:00 AM 11:30 PM
Destination (City, County, State)* Purpose of navel*
I
San Diego, San Diego, CA 40-:h Annual San Diego International Conference on
Clild and Family Maltreatment
..J
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
199 199 Government Rate Yes IV
Hotel Total* Conference Fee* Daily MME at Rental Car Cost per day*
D
1130 700 estination*............. I ................... 130
608.34
J 'Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
WA........... ------ -------------
Alaska Air 300 3523.34
Preparer's Name*
� Elisa Adolphsen
Preparers Title*
CAC Coordinator
Preapproved by FO/DH?* Use of travel card to fill a rental vehicle gas tank prior
Yes V to its return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Cornmittee* Date of Request* Travel Type*
Celina Garcia New Hope 10121/2024 Out of State Travel v
Departure Date* Return Date* Grant* Fund/Dept*
1/26/2026 1131/2025 Yes New Hope
05:00 AM 11:30 PM
Destination (City, County, State)* Purpose of Travel*
- - ------------- 1-
San Diego, San Diego, CA 40th Annual San Diego International Conference on
Clid and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
199 199 Government Rate No
Hotel Total* Conference Fee* Daily M&IE at Rental Car Cost per day*
1130 700 Destination* 0 ...........
473
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
-------------------------- -- --
Alaska Air 300 2603
Preparees Name*
E I i s a Adolphsen
Prepareils Title*
CAC Coordinator
Preapproved by EO/DH?** Use of travel card to fill a rental vehicle gas tank prior
Yes V to its return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Committee* Date of Request* Travel Type*
Sara MacDonald New Hope 10/21/2024 Out of State Travel v
. ............ - ......
Departure Date* Return Date* Grant* Fund/Dept*
... ...........
1/26/20252L1131/2025 Yes sl
ope
ope
J
06:00 AM 11:30 Pill
—j
Aoo
Destination (City, County, State)* Purpose of Travel*
San Diego, San Diego, CA 40th Annual San Diego International Conference on
Child and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
.. ..............
199 Government Rate V No
..j
Hotel Total* Conference FW, Daily MME at Rental Car Cost per day*
�&� ---- Destination*
1130 700 ................ .... V.VM 0
473
------------------ - --- -- -- ------------- ----
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Fillight* Total trip cost (Include all cost totals)*
Alaska Air 300 2603
Preparer"s Name*
.....................
[[.lira Adolphsen
Preparer's Title*
CAC Coordinator
Preapproved by EO/DH?* Use of travel card to fill a rental vehicle gas tank prior
Yes V to Its return is recommended.
OUT OF STATE TRAVEL REQUEST APPL(CATION
Traveler's Name* Dept/Commifttee* Date of Request* Travel Type*
Anthony Cortez -Morales Now Hope 10/21/2024 Out of State Travel v
Departure Date* Return Date* Grant* Fund/Dept*
1 f26/2025 1/31/2025 Yes New Hope
06:00 AM 11:30 PM
Destination (City, County, State)* Purpose of navel*
San Diego, San Diego, CA 40-,h Annual San Diego International Conference on
Child and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
-- -- -- -- ----
199 :199 Government Rate V No V
Hotel Total* Conference Feel" Daily MME at Rental Car Cost per day*
1130 700 Destination*
0
473
......... ... .. ...... .....
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
Alaska Air 300 2603
Preparees Name*
Efisa Adolphsen
Preparees Title
CAC Coordinator
Preapproved by EO/IDH?* Use of travel card to fill a rental vehicle gas tank prior
Yes V to its return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Committee* Date of Request* Travel Type*
-----------------
Elisa Adolphsen New Hope 1 0=121/2024 Out of State Travel Y
Departure Date* Return Date" Grant* Fund/Dept*
1/26/2025 1/3:11/2025 Yes New Hope
WPWI
05:00 AM 11:30 PM
Destination (City, County, State)* Purpose of Travel*
San Diego, San Diego, CA 40th Annual San Diego International Conference on
C ild and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
0 0 Government Rate Y No
Hotel Total*
Confere,ace Fee*
0 700
......... .....
Daily M&IE at Rental Car Cost per day*
Destination*
0
473
-- ---------- -------
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (include all cost totals)*
Alaska Air 300 1473
Preparer's Name*
[lira Adolphsen
Preapproved by EO/DH?*
Yes V
Preparer's Title*
CAC Coordinator
Use of travel card to fill a rental vehicle gas tank prior
to its return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Committee* Date of Request* Travel Type*
Trisha Glenn New Hope 10/21/2024 Out of State Travel v
j
Departure Date* Return Date* Grant* Fund/Dept*
E 1/26/2025 1131/2025 Yes�' New Hope
05:00 AM 11:30 PM
1h10%PkV§ %ky%ftM .6
Destination (City, County, State)* Purpose of Travel*
San Diego, an Diego, CA 40-:h Annual San Diego International Conference on
C ild and Family Maltreatment
Hotel - GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
----------- -
0 0 Government Rate Y No
Hotel Total* Conference Fee* Daily M&TE at
0 700 Destination*
473
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Rental Car Cost per day*
MA-4.0�wM
0
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
Alaska Air 300 1473
Preparer's Name*
Elisa Adolphsen
Preparer's Title
P----------
CAC Coordinator
Preapproved. by EC IDH?* Use of travel card to fill a rental vehicle gas tank prior
Yes V to its return is recommended.
OUT OF STATE TRAVEL REQUEST APPLICATION
Traveler's Name* Dept/Committee* Date of Request* Travel 1pe*
vi ki 0. k 0. 4 A 0
Laura Oronia New Hope 10/21/2024 Out of State Travel v
- -------------
Departure Date* Return Date* Grant* Fund/Dept*
E1/26/2025 EIE/31/2025 Yes New Hope
05:00 AM 11:30 PM
Destination (City, County, State)* Purpose of Travel*
-------- - .............
San Diego, San Diego, CA 40-:h Annual San Diego International Conference on
I ild and Family Maltreatment
-...
Hotel GSA Rate* Hotel - Nightly Rate* Cost Application* Rental Car Required
--- ----- --------
10
0 Government Rate No
- - -------- --
Hotel Total* Conference Fce* Daily M&IE at Rental Car Cost per day*
Destination*
0 700 0
473
------- ---
-------------------
Explanation for Rate (required if hotel cost is greater than per diem, or government rate)*
N/A
Air Carrier* Cost of Flight* Total trip cost (Include all cost totals)*
1. .-. N.
Alaska Air 300 1473
Preparer's Name*
Eli sa Adolphsen
Preapproved by EO/DH?*
Yes
LVA"
Preparer's Title*
- ------- - -------------------------------
CAC Coordinator
Use of travel card to fill a rental vehicle gas tank prior
to its return is recommended,