Student Trip Travel - LSU Eunice

Completion of this form is not a guarantee of coverage. Travel must meet all requirements outlined by the insurance policy. If you have any questions or would like to discuss program coverage please contact the Office of Risk Management.

Campus

LSU Eunice

Name of Organization/Department*

(e.g. School of Mass Communication, College of Engineering, etc.)

Destination*

(e.g. Bluebonnet Swamp)

City*

State*

Select or enter value

Mode of Travel*

Select or enter value

Who will be driving?*

Select

Driver's name*

Drivers Contact Information*

Date of Departure*

Date of Return*

Number of LSU Students Traveling*

(Please insert a number, no text characters)

Contact Person

Name*

Email*

Phone*

(Use xxx-xxx-xxxx format)

Data Authorization*

I authorize that all information provided on this form, including any and all personal, financial and academic data may be shared with the LSU Risk Management and university insurance carriers and vendors. This data will be securely retained indefinitely. To learn more about privacy at LSU, please see the LSU Privacy Statement.

Send me a copy of my responses

Privacy Notice|Report Abuse