Student Trip Travel - LSU AgCenter

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 AgCenter

Name of Organization/Department*

(e.g. St. Tammany 4-H, Northeast Region, Southeast Research Station etc.)

Destination*

(e.g. Bluebonnet Swamp, World Dary Expo, Awards Trip to Houston)

City*

State*

Select or enter value

Mode of Travel*

Select or enter value

Driver's name*

Who will be driving?*

Select

Drivers Contact Information*

Date of Departure*

Date of Return*

Number of Participants Traveling*

Please only enter a value greater than 0 if the person(s) traveling is not an LSU Employee. No other text characters are needed.

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.

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