Travel Authorization Request

Please fill in the following fields and click "Submit" when finished. An email version of this form will be sent to Lynn LaCombe and a Cc will also be sent to the email address provided below.

Date Submitted:

(DD/MM/YYYY)

Name:

Name :: e.g., First Last

Email:

Email :: e.g., user@fsu.edu

Funding Source:

Funding Source :: e.g., Fund Name

Destination:

Destination :: e.g., Street, City, State, Country

Departure Information:

Return Information:

Purpose of Trip:

Purpose of Trip :: e.g., Conference

Name of Meeting/Conference:

Name of Meeting/Conference :: e.g., Meeting/Conference Name

Benefit to the State/Sponsored Project:

Benefit to the State/Sponsored Project :: e.g., To further education

Others from department attending:

Others from department attending :: e.g., Name1, Name2

What Courses Do You Teach:

Who Will Cover These Courses For You?

Emergency Contact(s):

Emergency Contact(s) :: e.g., Name and Phone/Mobile #

Will any portion of this trip be personal leave?

Yes       No     If yes, please give dates:

Details:

FUNDS REQUESTED?       Yes     No       (If yes, please fill out details below.)

Verification