Common Contracts
1 similar Student Travel Agreement contracts
APPENDIX B STUDENT TRAVEL AGREEMENT & ASSUMPTION OF RISK/GENERAL RELEASE FORMStudent Travel Agreement • November 9th, 2016
Student ID number Attachments First Name Last name Date of birth Cell phone number Accept Travel Award by checking this box, you are accepting your travel reimbursement award. You are also acknowledging that you understand that funding will only be reimbursed in the event that you follow the Student Travel Reimbursement Policy, the Student Code, and any requirements for the meeting/conference. Are you driving yourself? If yes, do you have a valid driver's license? If yes, do you have valid car insurance? It is required that you have at least state minimum liability coverage on the vehicle you will be driving. Are you traveling with a faculty/staff member? If yes, please provide the faculty/staff member's name Emergency Contact name Emergency Contact address Emergency Contact phone number Emergency Contact alternate phone number Your relationship to Emergency Contact Primary Physician Primary Physician's phone number Health Insurance Provider Policy Number
