Domestic and International Student Trip Documentation

Domestic and International Student Trip Documentation

Complete this form if you are planning a student trip and the trip meets the requirements found in the Trip Guidelines for Clery.

Last Name

First Name

Contact E-Mail

Sponsoring Department or University Organization

CSA Training Completed

Yes
No

Start Date of Trip

Start Date of Trip
	Month	Day	Year



Start Date of Trip:	Month - Start Date of Trip:	Day - Start Date of Trip:	Year - Start Date of Trip:

End Date of Trip

<div>End Date of Trip</div>
	Month	Day	Year



End Date of Trip:	Month - End Date of Trip:	Day - End Date of Trip:	Year - End Date of Trip:

Hotel, Building Name, etc.

Street Address

City

State

Zip Code

Country (If other than USA)

Occupied Room Numbers, Floors, etc.

Contact Information for Police or Jurisdiction Visiting

E-Mail

Jurisdiction Address

Jurisdiction Phone Number

Any Comments?