1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463
Student Travel Itinerary
Name of campus contact person (not traveling):
Phone number: _______________________
Name of event (if applicable)
Organization sponsoring trip
Phone number at destination:
Faculty/staff traveling with group:
Expected date and time of departure from Butte:
Expected date and time of return to Butte:
If traveling for more than one day, provide expected route of travel and hotel accommodations if
different than location of event.
Montana Tech vehicle: Car Activity bus SUV Minivan
Personal vehicle
Air- Name of airline _________________
Charter bus- Name of company ____________________
Other- please identify ______________________
If traveling by activity bus, SUV, or minivan, list all certified drivers:
Number of students/faculty/staff traveling:
Form completed by: _____________________________ Date: _______________________
Title: __________________________
Copy the attached Emergency Contact List with all appropriate information and turn in on the day of travel.
