EMPLOYEE RELOCATION: REIMBURSEMENT REQUEST FOR FACULTY
SECTION I: TO BE COMPLETED BY FACULTY MEMBER
NAME ________________________________________
APPOINTMENT DATE ___________________
RUTGERS EMPLOYEE ID ____________________
DEPARTMENT _____________________________________________
SCHOOL __________________________________________
CAMPUS
___________________________
ACADEMIC AND ADMINISTRATIVE TITLES _____________________________________________________________
MOVING FROM ______________________________________________________________________________________
STREET
CITY
STATE
ZIP CODE
MOVING TO ________________________________________________________________________________________
STREET
CITY
STATE
ZIP CODE
TOTAL MILEAGE ONE WAY ________________
COMMERCIAL VENDOR USED ________________________________________
OTHER MOVING EXPENSES (list):
AMT:
$ ___________
$___________ ________________________
$___________ ________________________
$___________ ________________________
TOTAL REIMBURSEMENT REQUESTED:
$__________________ (Attach all original receipts.)
It is understood that I will comply with the Rutgers University (“University”) Employee Relocation Policy (Section 60.1.6).
This agreement is not a contract for employment or appointment, nor a guarantee, if employed, of continued employment for a
specific period. It is further understood that the University will be held harmless for any loss or damage to property or injury to
any individual that may occur as a result of the relocation.
SECTION II: APPROVALS
______________________________________________________
Faculty Signature
Date
Approved Relocation Reimbursement Amount:
Check Amount:
APPROVALS
Requesting Department Chair :
Date:
Budget/Grant Officer:
Date:
Dean:
Date:
Rutgers Employee Relocation Policy Form (Section 60.1.6)
Form Revised November 2013
Instructions:
1. Faculty member completes top section, signs and provides all original receipts for reimbursement.
2. Department Chair approves Relocation Reimbursement request.
3. Dean approves Relocation Reimbursement request.
4. Budget Officer reviews reimbursement request against the Employee Relocation Policy, Section
60.1.6 and approves final amount for reimbursement.
5. Budget Officer forwards Relocation Reimbursement request to the Payroll Department for processing.
6. Payroll will process the request and forward the reimbursement payment to the faculty member
directly. Payroll will also calculate the appropriate taxes. It is the responsibility of the faculty
member to assume any tax liability in accordance with the IRS Publication 521 – Moving Expenses
(http://www.irs.gov/pub/irs-pdf/p521.pdf).
Distribution:
cc: Department, School Faculty Affairs Office, Budget Office and Payroll.
Rutgers Employee Relocation Policy Form (Section 60.1.6)
Form Revised November 2013