Employee Information

If you are requesting insurance for more then one person, please complete this form for each person or attach a sheet with each travelers name, LSU ID, email, and phone number.
 

 
If attaching group list, please type "See Attachment".
 
If attaching group list, please type "See Attachment".
 
If attaching group list, please type "See Attachment".
 
If attaching group list, please type "See Attachment".
 
For annual employees, divide annual salary by 365 x number of days traveling. If attaching group list, please type "See Attachment".
 

Trip Information

 

 
 
 
 
 
ie: State Department, Department of Defense
 
 
 

Billing Information

 

 
 
 
 
 

Required Attachments

 

 
Please attach: - Itinerary - Contract/Grant
Drop your files here