Instructions: Complete and
submit, along with a copy of the driver’s license of each student who will
operate one of the university-owned vehicles at any time during the trip, to
the Texas State Facilities Department for university approval at least 10
working days prior to the date of departure.
Please print or type the
requested information of the driver, driver’s license, and insurance for those
traveling with the group.
|
University Approved
Driver* |
Copy of Driver’s License |
Copy of Insurance |
|
________________________ |
_______________ |
__________________________ |
|
________________________ |
_______________ |
__________________________ |
|
________________________ |
_______________ |
__________________________ |
|
________________________ |
_______________ |
__________________________ |
|
________________________ |
_______________ |
__________________________ |
Please print or type the
requested information of the student organization’s members or sponsored program
participants traveling with the group.
|
Name & ID or SS#* |
Relationship to |
Emergency Contact/Phone |
Allergies, Illness or Special Needs |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
|
______________________ |
_______________ |
______________ |
_________________________ |
*Please be
advised that the students or persons whose names are listed on this form agree
to allow a university representative to contact the emergency contact person in
the event of an emergency or other situation requiring the need to do so.
Additional forms may be attached as needed.