STUDENT TRAVEL REQUEST FORM
This form should be completed and returned to Patricia Moody, the Director of Academic Finance in the Dean of
Faculty’s Office (Williams 232) well in advance of your proposed travel. Please make sure that the faculty member
who you will be accompanying plus the chairperson of the department sign off on this form on the appropriate lines
below. Once your trip has been approved by the Dean of Faculty’s Office, we will return this form to you.
NAME: ___________________________________
Box #:___________________________
Purpose of trip: _____________________________________________
Location: __________________________________________________
Date(s): ___________________________________________________
Faculty Advisor or Sponsor: ___________________________________
Participation: ________________________________________________
Estimated expenses:
Reimbursement approved:
Transportation
$ _________________
Full
Partial
None
Registration
$ _________________
Full
Partial
None
Hotel
$ _________________
Full
Partial
None
Miscellaneous
(please explain below)
$ _________________
Full
Partial
None
TOTAL:
$ _________________
Student signature _______________________________________
Date: ________________________
Faculty member Signature _________________________________
Date: ________________________
Chair/Director Signature _________________________________
Date: __________________________
Approved: ___________________________________________
Date: _________________________
March 2016