Sandhills Community College
Field Trip Transportation Authorization
Faculty or staff members who take groups from campus on trips are required to complete this form and return it
to the Dean of Instruction’s office (if group involves curriculum students) or the Vice President of
Continuing Education’s office (if the group involves continuing education students) at least three (3) working days
prior to the scheduled trip. A license check is required for all drivers. In addition, a roster of all students
participating in the trip should be attached to this form.
Name of driver: _________________________________ Date: __________________
Driver’s date of birth: ________________ Driver’s license number: _______________
Name of course of which field trip is a part: ___________________________________
Purpose of trip [including detail on the purpose and objectives of the trip]:
________________________________________________________________________
________________________________________________________________________
Destination(s): ___________________________________________________________
Date travel begins: __________________ Date travel ends: ______________________
Departure time: _______ a.m. p.m. Return time: ______ a.m. p.m.
Type of transportation: Car Van Other School Private
I, _____________________________________, authorize Sandhills Community College
(Driver’s printed name)
to complete a driver’s license check on my license.
____________________________________
(Driver’s Signature)
Travel requested by:
___________________ _____________________________________
(Date) (Faculty / Staff Member / Student)
For Office Use Only
Result of driver’s license check: approved denied
________________________________ ________________________
(Dean of Instruction for curriculum students)*
(Date)
_______________________________ ________________________
(VP of Continuing Education for continuing education students)* (Date)
________________________ ________________________________
(Executive Vice Presid
entafter license check / insurance)**
(Date)
*
Approval pending Executive Vice President's driver’s license check.
**A
fter approval/denial, the original will be forwarded to the Maintenance Department with a copy to the originator.
________________________________ ________________________
(Department Chair/Supervisor) *
(Date)
Edited Au
g 2017
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