College of Agriculture Student Travel Emergency Contact Form

Please submit the following form prior to participating in any travel associated with your academic course:

denotes required fields.

First name of student (traveler)

Last name of student (traveler)

Student (traveler) email address

Student (traveler) phone number

Class sponsoring and/or affiliated with trip

Faculty and/or instructor leading trip

Trip Destination Please describe the destination of your trip.

Departure Date & Time

Indicate the day and time in which you will depart for your trip.

Expected Return Date & Time

Indicate the date and time in which you will return from your trip.

Traveler's emergency contact Please provide the first and last name of your primary emergency contact.

Emergency contact phone number Please list the phone number for your emergency contact.

Relationship with emergency contact Please describe your relationship with your emergency contact (i.e. mom, friend, boss)