STUDENT CAUCUS TRAVEL REQUEST FORM
FOR “INTER-ISLAND TRAVEL”
[updated 08/15/2016]
Name of Student*:
Email: Phone No.
Birthdate
(Mo/Day/Yr): Gender: Female Male
Name of Your Campus:
*Note: The name you provide MUST match the government-issued ID
(i.e. driver’s license) that you bring to the airport.
Please check one box for your origin and one box for your destination: Travel arrangements will
be made to reflect attendance at the scheduled meeting only. Times for departure and return
must be within reason of the scheduled meeting times.
Note: Flight departure and return times will be made to coincide with caucus meeting start and
end times.
By signing this travel request form, I understand that, should I be unable to travel after a
reservation has been made by the University, I must notify the Office of the Associate
Vice President for Student Affairs by 12 noon on the day before the scheduled Student
Caucus meeting. If I am unable to do so, I will call the airline directly to cancel the flight.
I am liable for costs incurred should I miss or change my flight after a confirmed
reservation has been made, and an administrative “hold” will be placed on my student
status (preventing registration changes, transcript orders, diploma orders, etc.) until the
payment has been made in full .
Signature (if e-mailing, please type your name here)
Please E-mail to: Russell Chan
Office of the VP for Student Affairs
Email: chanr@hawaii.edu
