Instructions: For all student organizations traveling to an off-campus location (10 miles or more outside of the West Plains city limits). Student organizations must complete and submit this form, as well as the vehicle and passenger information form, to the Office of Student Life and Development prior to your trip. It is optional but recommended to keep a copy of these trip records.

Organization:
Advisor: Advisor: First Last
Advisor Phone: Advisor Phone: - ### - ### ####
Advisor's Email:
Reason for Trip:
Destination Address: Destination Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Departure Date: Departure Date: / MM / DD YYYY
Return Date: Return Date: / MM / DD YYYY
**NOTE: If you know in advance a list of multiple dates your organization will be taking a trip for the same reason, it is encouraged to provide a list of departure and return dates below. This will prevent from having to submit multiple forms throughout the year.
Extra departure and return dates if known:
Overnight Trip?

Overnight Trip? Yes No
Overnight Trip Information:
The following lodging information is to be completed for overnight trips only.
Name of Lodging Venue:
Lodging Venue Phone: Lodging Venue Phone: - ### - ### ####
Lodging Address: Lodging Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Vehicle and Passenger Information
Mode of Transportation:
Driver: Driver: First Last
Driver's Phone: Driver's Phone: - ### - ### ####
Driver's BearPass #
Passenger 1:
Name (P01): Name (P01): First Last
Phone (P01): Phone (P01): - ### - ### ####
BearPass# (P01)
Additional Passenger 2?

Additional Passenger 2? Yes No
Passenger 2:
Name (P02): Name (P02): First Last
Phone (P02): Phone (P02): - ### - ### ####
BearPass# (P02)
Additional Passenger 3?

Additional Passenger 3? Yes No
Passenger 3:
Name (P03): Name (P03): First Last
Phone (P03): Phone (P03): - ### - ### ####
BearPass# (P03)
Additional Passenger 4?

Additional Passenger 4? Yes No
Passenger 4:
Name (P04): Name (P04): First Last
Phone (P04): Phone (P04): - ### - ### ####
BearPass# (P04)
Additional Passenger 5?

Additional Passenger 5? Yes No
Passenger 5:
Name (P05): Name (P05): First Last
Phone (P05): Phone (P05): - ### - ### ####
BearPass# (P05):
Additional Passenger 6?

Additional Passenger 6? Yes No
Passenger 6:
Name (P06): Name (P06): First Last
Phone (P06): Phone (P06): - ### - ### ####
BearPass# (P06):
Additional Passenger 7?

Additional Passenger 7? Yes No
Passenger 7:
Name (P07): Name (P07): First Last
Phone (P07): Phone (P07): - ### - ### ####
BearPass# (P07):
Additional Passenger 8?

Additional Passenger 8? Yes No
Passenger 8:
Name (P08): Name (P08): First Last
Phone (P08): Phone (P08): - ### - ### ####
BearPass# (P08):
Additional Passenger 9?

Additional Passenger 9? Yes No
Passenger 9:
Name (P09): Name (P09): First Last
Phone (P09): Phone (P09): - ### - ### ####
BearPass# (P09):
Additional Passenger 10?

Additional Passenger 10? Yes No
Passenger 10:
Name (P10): Name (P10): First Last
Phone (P10): Phone (P10): - ### - ### ####
BearPass# (P10):
Signature Date: Signature Date: / MM / DD YYYY
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Full Name

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**NOTE: If you know in advance a list of multiple dates your organization will be taking a trip for the same reason, it is encouraged to provide a list of departure and return dates below. This will prevent from having to submit multiple forms throughout the year.

Overnight Trip Information:
The following lodging information is to be completed for overnight trips only.

Vehicle and Passenger Information

Passenger 1:

Passenger 2:

Passenger 3:

Passenger 4:

Passenger 5:

Passenger 6:

Passenger 7:

Passenger 8:

Passenger 9:

Passenger 10: