TRAVEL CONTACT INFORMATION

I understand that I am a Campus Security Authority (CSA) for this trip and must report to Campus Safety in a timely manner any crimes brought to my attention.

Name:

Title:

Department:

Phone:

Barton Community College email:

Names of other CSAs traveling on this trip:

TRAVEL DATES

Check-In Date and time:

Check-Out Date and time:

Number of Nights in this Facility:

LODGING FACILITY INFORMATION

Note: If group is staying at more than one lodging facility, please complete a separate form for EACH facility.

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Specific floor(s), room number(s), or unit number(s) occupied:

THIS TRIP IS: Select from the list a one-time trip repeated each semester repeated annually Other

If you selected Other above, please explain:

If trip is repeated, our group: Select from the list Always stays at the exact same lodging facility Uses various lodging facilities with each trip Not Repeated