Off-Campus Trip Request Form
(To be submitted a minimum of 2 weeks prior to trip)
School/Department/Unit Class Catalog number
Name of class/organization
Students participating in this trip will miss (please check one):
No classes
Half a day or less of classes
One day of classes
Two days of classes
Departure Date Departure Time
Return Date R
eturn Time
Destination of trip
Purpose of trip
Method of travel
Cost to school/department/unit
I have confirmed insurance coverage for any private vehicle drivers
(Any student driver must be 21 or over.) (Signature of professor/sponsor)
(PRINT name of Professor/Sponsor)
(SIGNATURE of Professor/Sponsor) Date
(Signature of School/Department Dean/Chair/Unit Dir.) Date
(Signature of Assoc. VP for Academic Admin.) Date
Please attach a list of students (include ID numbers) who plan to go on this trip. For extended
trips, provide the Associate Vice President for Academic Administration Office with an
itinerary. Call the Associate VP (ext. 2912) or send e-mail (academicadmin@southern.edu) to
verify the names of the participants the day after you return.
It is the responsibility of the trip sponsor to advise students to make arrangements with their
other teachers about making up work that is missed.
More than two days
o
f classes
(requires Undergraduate Council approval
at least one semester prior to trip)
Approved by UG council on
click to sign
signature
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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