Revised 4/11/18
OF
F CAMPUS INDIVIDUAL/GROUP VISITATIONS
This form must be completed for all off campus trips, including those that do not require class excuses
Submit in Triplicate Five (5) Working Days Prior to Date of Trip in State
Submit in Triplicate Three (3) Weeks Prior to Date of Trip Out of State
This form, when approved by the Provost and Dean of Students/ Vice President for Student Affairs, will serve
as: 1) the official university excuse for classes missed while on a university-approved trip or event, and 2) as a source of
information in emergency situations. Each student listed must receive a copy of the approved form and show it to his or her
instructors prior to the trip. The student is responsible for making arrangements to make up any course work missed
during the approved trip. Students also will be responsible for adhering to applicable state and local laws, the
Student Code of Conduct, Drug and Alcohol Policy, and other university rules and regulations.
Faculty and students should consult the current general catalogue to determine activities for which excuses will be
granted.
IMPORTANT NOTE: Students must follow all State travel regulations including taking the defensive driving course
if: 1) driving a university vehicle; or 2) mileage reimbursement is being sought.
Name of Group ________________________________ Date & Time of Departure ______________________________
Destination ___________________________________ Date & Time of Return _________________________________
Date & Time of Meeting/Conference/Event ______________________________________________________________
Purpose and/or Justification of Proposed Trip ____________________________________________________________
_________________________________________________________________________________________________
Meth
od of Travel: University Vehicle __________ Faculty/Staff Vehicle __________
Student Vehicle __________ Other (explain) __________
Driver(s) _______________________________________________
Driver’s License Number___________________________________
Vehicle Insurance Policy Number and Name of Company __________________________________________________
(A photocopy of vehicle insurance and driver’s license must be attached for each driver)
Nam
es of Students Making Trip (Alphabetical Order) with their University I.D. #. If more space is needed please lists
names with University I.D. # on a separate sheet and attach to each copy of this form.
In addition, if class(es) will be missed, please attach a copy of each student’s
class schedule which includes days and times for each class.
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
Contact for Trip: _______________________ Emergency Telephone Number (cell phone, hotel) __________________
Date Submitted: _______________________ Signed: ____________________________________ ___________
(Instructor/Faculty/Advisor) Date
APPROVED FOR ABSENCE:
_____________________________________ ___________ _____________________________________ ___________
Department Head/Director Date
Dean of College
Date
_____________________________________ ___________ _____________________________________ ___________
Dean/Vice President for Student Affairs Date Provost Date
Dean of Students
Student Union RM 2409, SLU 10346, Hammond, LA 70402 | Phone: (985)
549-3792 Fax: (985) 549-5647 | deanofstudents@southeastern.edu
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