Student Travel/Absence Form

This request must be approved by the Associate Dean for Undergraduate Academic Affairs. Your request should be made at least 6 weeks before a trip is to take place to allow time for these approvals.

Please supply the following information. It will be emailed to Ryanne Arecheja and Kate Fitzpatrick to initiate the approval process. Contact them with any questions.

Sign in to Google to save your progress. Learn more
Email *
Date(s) of Absence:
*
Name of Group: 
*
Names of Supervising Faculty:
*
Students Involved (names + uniqnames): (find uniqnames in Mcommunity)

Please enter student's names as Last name, First name (uniqname)
*
Curricular Objective of Trip/Event
Description of Trip/Event: 
*
Curricular Objective of Trip/Event
Learning Objectives of Trip/Event: 
*
Curricular Objective of Trip/Event
Is this a required activity?
*
Curricular Objective of Trip/Event
If required and student is unable to attend, what curricular provisions will be made?
*
Cost & Support
What is the cost for the students on the trip? What financial support or meals/housing will be provided?
*
Itinerary/Schedule 
If you have the schedule in a document, please copy the text and paste it here; othewise, provide a brief description of the schedule.
*
Student Medical Information
While we hope it will be unnecessary, the medical information of students traveling on SMTD-sponsored activities should be on file with the trip organizers prior to departure. Supervising faculty should have access to this information during the trip in case of emergency. See here for a sample form that can be adapted to your trip.
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Michigan. Report Abuse