Viterbo University Student Travel Request Form
This travel request form must be submitted at least 2 weeks in advance of the proposed date(s) of travel.  Required student travel beyond 5 miles from the Viterbo campus must be approved.
   
Requester's Information
  Name of person completing this form:
  Contact phone number:
  Contact email address:
 
  Travel Request Information
  Type of student group: .
  Student group name or individual traveling:
   
 
 Date(s) of travel - Departure date  [None] Select a Date Delete the Date
                          - Return date  [None] Select a Date Delete the Date
 
                            Time leaving Viterbo:
                     Time returning to Viterbo:
 
 Will this travel occur on other dates? If so, please list all the other dates that this travel will occur.
 
 Destination venue, city, and state: 
 Reason for travel:
 
 Mode of transportation:
 
  For information about Viterbo's fleet vehicles, go to: http://www.viterbo.edu/physplant.aspx?id=48736.
 
 Will this be an overnight trip?
 Overnight Trip Information:
 Add Lodging name, address and phone number.
 
 Please explain your itinerary for your day(s) there. Include what you might do during any free time.
   
 
  Expenses:
 How much money is a participant paying out of pocket on this trip?
   
 How much money is being taken out of University accounts for this trip?
   
 Please explain any additional cost.
   
 
 Participant Information:
 Number of people attending: 
 
 Provide a list of ALL students’ and trip leaders’ full names and Viterbo ID #s (the seven numbers following 99 on your id card) for who will be traveling - example on ID = 990012345 then the student id = 0012345: You may also get these id's from your class roster.
   
 Viterbo ID #s are obtained so the designated supervisor for the travel can collect emergency contact and medical information on each travel participant. Please assure that each travel participant’s emergency contact and medical information is up to date in VitNet. This information is located in the Student tab under Academic Profile, and click on Emergency Contact.  www.viterbo.edu/vitnet 
 
Trip Leader(s) Information:
 Trip Leader 1:   Cell phone number:
 Trip Leader 2:   Cell phone number:
 
 Please describe any significant concerns or risks related to the travel, include weather related concerns.