Revised 7/11/16
OFF 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 Assistant 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 ____________________________________________________________
_________________________________________________________________________________________________
Method of Travel: University Vehicle __________ Faculty/Staff Vehicle __________
Student Vehicle __________ Other (explain) __________
Driver(s)
_______________________________________________
Driv
er’s License Number
___________________________________
Ve
hicle Insurance Policy Number and Name of Company __________________________________________________
(A photocopy of proof of insurance and driver’s license must be attached for each driver)
Names 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.
Attach a copy of each student’s class schedule.
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
_______________________________ _______________________________ ________________________________
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/Students Date
_____________________________________ ___________ _____________________________________ ___________
Assistant Vice President for Student Affairs Date Provost Date
