Clery Act Student Travel Form

Group Name *

Travel Contact's Name *

First

Last

Travel Contact's Department *

Travel Contact's Email *

Travel Contact's Phone *

Departure from Drury *

Return to Drury *

Lodging Facility's Name *

Lodging Facility's Address *

Address Line 1

Address Line 2

City

State

Zip Code

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

This trip is: *

Person submitting this form's name: *

First

Last

Today's date: *

Additional notes about the trip: