Clery Act Student Travel Form

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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: