STUDENT TRAVEL REQUEST
Date of Request:
Purpose of Trip:
*Mode of Travel (Select all that apply): Air
Rose Vehicle
(If by air, include a copy of each student(s) flight itinerary)
TIME:
AM
Departure Time:
DAY:
Personal Vehicle
PM
MONTH:
YEAR:
TIME:
AM
PM
DAY:
MONTH:
YEAR:
Bus
Train
✔
Estimated Time of Return:
Department:
Destination:
Faculty/Staff Supervising trip: YES
NO
If YES, name of supervisor:
*If a Rose-Hulman vehicle or rental vehicle will be driven by a student(s), the student(s) must be listed on
the “Occasional Operator” list before they will be authorized to drive and an RHIT employee must be
present for the duration of the trip. When applicable, please designate the student authorized driver on
this form or roster with an asterisk (*):
ROSTER OF PERSONS ATTENDING: (Attach class roster or list individually.)
Please email completed form to the Manager of Insurance and Risk Management prior to departure
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