Clery Act Student Travel Form

Group Name

Travel Contact's Name

First

Last

Travel Contact's Department

Travel Contact's Email

Travel Contact's Phone

Departure from Drury

Return to Drury

Lodging Facility's Name

Lodging Facility's Address

Address Line 1

Address Line 2

City

State

Zip Code

Specific floor(s), room number(s), or unit number(s) occupied

This trip is:

Person submitting this form's name:

First

Last

Today's date:

Additional notes about the trip: