Student Trip Travel - LSU A&M

Completion of this form is not a guarantee of coverage. Events 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 A&M

File Attachments

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First Name*

Last Name*

Email*

Phone*

(Use xxx-xxx-xxxx format with no parentheses around area code)

Course*

(e.g. MC, ACCT, RNR, etc.)

Select or enter value

Course Number*

Enter "1" for Student Organization or Department Travel Enter course number for all other instances (e.g. 1001, 3000, etc.) Please place one course per entry. If you are traveling for multiple courses, please provide a new entry for each course. Only NUMBERS must be inserted into this selection.

Section Number

Please enter a value between 1 and 200 (section number as seen on your class schedule)

Destination*

(e.g. Baton Rouge Food Bank) Please only insert ONE location per entry. If you are traveling to multiple locations, please re-complete this form.

City*

State*

Select or enter value

Mode of Travel*

Select or enter value

Select Date of Service*

Additional Date 1

Additional Date 2

Additional Date 3

Additional Date 4

Additional Date 5

Additional Date 6

Additional Date 7

Additional Date 8

Additional Date 9

Additional Date 10

Additional Date 11

Additional Date 12

Additional Date 13

Additional Date 14

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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