Sandhills Community College
Authorization for College Sanctioned Extended Travel
For insurance purposes, faculty or staff members who take groups from campus on extended trips are
required to complete this form and return it to the dean of instruction’s office (if group involves
curriculum students) or the dean of continuing education’s office (if group involves continuing
education students) at least one month prior to embarking on the scheduled trip. A roster of all
students participating in the trip should be attached to this form.
Name of college employee coordinating trip: _________________________________
Name of course or campus group for which trip is planned: _____________________
Purpose of trip [including detail on the purpose and objectives of the trip]:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Destination(s):
_____________________________________________________________________
_____________________________________________________________________
Number of participants [Please attach a current roster.]: __________________________
Trip begins: ___________________________ Trip ends: _____________________
(Month / Day / Year) (Month / Day / Year)
Type of transportation [check one]: Car Van Other / School
Private
Study Abroad Insurance has been reviewed/discussed with the administrative assistant to the vice
president for business and administrative services (x3702)
Yes No
Requested by
(Faculty / Staff Member) Date
: ______________________________ ________________________
For Office Use Only
Approved by
:
__________________________________________ ________________________
(Supervisor) Date
____________________________________________________ ______________________________
(Dean of Instruction (curriculum students)* Date
_____________________________________________________ ______________________________
(Dean of Continuing Education (continuing education students)* Date
_____________________________________________________ _______________________________
Vice President for Business and Administrative Services Date
[Pending liability insurance clearance]
*Dean will approve form pending insurance review and clearance by Vice President for Business and
Administrative Services.
