ࡱ> QmP  !"#$%&'()*+,-./0123456789:;<=>?@AUCDEFGHIJKLMNOSTVWXYZ[\]^_`abcdefghijklopqrstuvwxyz{|}~Root Entry Fq 6RWordDocument7Data B1Tablen5a  bjbj[[ 79bE\9bE\) ttttt8$G0f///////$1c4/t"/tt0w!w!w!Ftt/w!/w!w!F-|./ 6^-/00G0-4S4$.4t."%w!=Q^//S $G04 > ::  Division of Student Affairs NOTIFICATION OF OFF-CAMPUS TRAVEL FOR STUDENT ORGANIZATIONS (Dean of Students Fax 4652) I. IDENTIFICATIONRegistered Student OrganizationExt.: Fax #:Purpose of Trip:Expected Timeframe for Absence from Campus:From a.m.p.m.onToa.m.p.m.onName of Chaperone:Cell #:Mode of Transportation:Insurance coverage (if private transportation):II. ITINERARY: (Please list information for where members of the group can be reached in case of emergency. Continue on back if necessary.)ADDRESS (City, Hotel, Institution, etc.)DATE AND HOURIII. MEMBERS OF GROUP: (Please list names and departments for students and faculty. Designate faculty by placing an F after their names. Continue on back if necessary.)ADDRESS (City, Hotel, Institution, etc.)DATE AND HOUR SIGNATURESChaperoneDateDean of Student Activities DateDean of Student Life DateNOTE: Registered StudentOrganizationsare responsible for faxing a completed copy to the Office of Student Involvement and Leadership at 575-4613 and UAPB Campus Police at 575-4662/8029.     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