Farmingdale State College State University of New York REQUEST FOR STUDENT TRAVEL DEPARTMENT: NUMBER OF STUDENTS: SUBJECT/COURSE SECTION NUMBER FACULTY/STAFF PARTICIPATING: CAMPUS PHONE # CELL PHONE # DESTINATION (address, city, state): PURPOSE OF THE TRIP: DATE OF TRIP: TIME (departure): TIME (return): TRANSPORTATION / HOUSING ARRANGEMENTS: APPROVED: (Dept. Chair/Director) DATE : _______________________________________ _____________ REMARKS: APPROVED BY DEAN: DATE: APPROVED BY or DESIGNEE: V.P. FOR ACADEMIC AFFAIRS TITLE: DATE: or APPROVED BY or DESIGNEE: V.P. FOR STUDENT AFFAIRS TITLE: DATE: Attach a list of students, faculty/staff and their emergency contact information including and emergency name and phone number. Please forward attendee’s name contact’s signed form(s) to: for processing. Office of the Associate Provost, 130 Horton Hall, Faculty/Staff & Student Emergency Contact Information please type –
Farmingdale State College State University of New York REQUEST FOR STUDENT TRAVEL DEPARTMENT: NUMBER OF STUDENTS: SUBJECT/COURSE SECTION NUMBER FACULTY/STAFF PARTICIPATING: CAMPUS PHONE # CELL PHONE # DESTINATION (address, city, state): PURPOSE OF THE TRIP: DATE OF TRIP: TIME (departure): TIME (return): TRANSPORTATION / HOUSING ARRANGEMENTS: APPROVED: (Dept. Chair/Director) _______________________________________ DATE : _____________ REMARKS: APPROVED BY DEAN: DATE: APPROVED BY V.P. FOR ACADEMIC AFFAIRS or DESIGNEE: TITLE: DATE: or APPROVED BY V.P. FOR STUDENT AFFAIRS or DESIGNEE: TITLE: DATE: Attach a list of students, faculty/staff and their emergency contact information including attendee’s name and emergency contact’s name and phone number. Please forward signed form(s) to: Office of the Associate Provost, 130 Horton Hall, for processing. Faculty/Staff & Student Emergency Contact Information – please type