Fillable Compliance Clery Act Student Hotel / Student Housing (Northwestern State University)

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Compliance Clery Act Student Hotel / Student Housing (Northwestern State University)

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University Safety &
Compliance
Clery Act Student Hotel / Student Housing Form (National & International)
This form is to be completed for University-related travel with students for anticipated travel
time of 48hrs or more. Information provided will assist the University in meeting requirements
under the Clery Act.
Group Name/Class:
Travel Contact:
Name Title
Department Phone Email
Lodging Facility Information:
Note: If group is staying at more than one lodging facility, complete a separate form for EACH facility.
Name:
Address:
Travel Dates: Check-In / / Check-Out / /
Law Enforcement Agency Having Jurisdiction for the lodging facility:
Note: Your lodging facility may be able to provide you with this information.
Agency Name:
Agency Mailing Address:
Phone Number: _______
Agency Email Address (if known):
Email Completed form to:
calistej@nsula.edu
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Compliance Clery Act Student Hotel Student Housing (Northwestern State University)

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Completed 24 August 2020

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