Idaho State University
Clery Act Student Travel
This form is to be completed AFTER THE TRIP for any University-related overnight travel that
includes students such as athletics, academics, clubs/organizations, etc.
Travel Contact:
Name Title
Department Phone Email
This trip for an individual student or a group of students:
Individual student
Group name:
Group Leader:
**I understand that I am a Campus Security Authority (CSA) for this trip and must report to
Public Safety in a timely manner any crimes brought to my attention.**
Travel Dates: Check-in date Check-out date
Lodging Facility Information:
Note: If student(s) staying at more than one lodging facility, please complete a separate form for EACH facility.
Name
Street Address
City, State, Zip
Specific floor(s), room number(s), or unit number(s) occupied
Space rented besides lodging (i.e. classrooms, parking spaces, practice facilities, etc.)
Note: If student(s) using more than one facility besides lodging, please complete a separate form for EACH facility.
Name
Street Address
City, State, Zip
Specific floor(s), room number(s), or unit number(s) occupied
This trip is:
a one-time trip repeated each semester/year other
If trip is repeated, student(s):
always stays at the exact same lodging facility uses various lodging facilities with each trip
Person submitting form:
Name Signature Date
Submit this completed form to: clery@isu.edu
For questions, contact the Clery Compliance Coordinator at (208) 282-2515
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