Department:
Name of person or persons traveling:
Name of trip planner:
Drivers and Trip leaders (1 each per vehicle):
Contact Information for trip planner:
Email:
Office phone:
Home phone:
Address of destination or destinations, if more than one:
Approximate mileage from campus to final destination:
Estimated driving time and planned breaks:
Purpose of trip:
Date and time of departure from campus:
Date and time returning to campus:
Vehicle type requested (van/size, full, mid, compact car):
Driver License Numbers (required for each driver):
I have read and am fully informed about the Vehicle and Golf Cart Safety Policies and Procedures: Yes No
Student or student groups must obtain a signature from the advisor or coach before travel willl be authorized. Please ask advisor/coach to review and sign this request.
By signing below, I acknowledged that I have reviewed the Vehicle and Golf Cart Safety Policies and Procedures with each trip leader and driver.
Advisor/Coach Signature: ___________________________________
Date: ______________ Email and phone: ___________________________________