Individual Completing Form

First Name *

Last Name *

Phone Number

Email Address *

Travel Details

Reason for travel *

Name of department/individual making travel arrangements *

Location name *

Location address *

Location City *

Location country *

Location state

Location zip code *

Arrival date *

Departure date *

Does this trip occur annually? *

Yes

No

Do students generally stay at the same lodging facility each year? *

Yes

No

Will the university/department be entering into a written agreement to use space at another institution or facility during this trip? * 🛈

Yes

No

Name *

Address *

City *

State

Country *

Zip Code *

Specific type of space being used *

Faculty/Staff Attending Trip

The names of all faculty or staff that will be attending the trip must be provided so they can complete the required Campus Security Authority training prior to the trip.

	Name	Phone	Email
1.	Name	Phone	Email
2.	Name	Phone	Email
3.	Name	Phone	Email
4.	Name	Phone	Email
5.	Name	Phone	Email
6.	Name	Phone	Email

Other Information

If you have any other information you would like to include, please do so below. *