Home »Associate Vice President of Student Affairs »First-Generation Students Please RSVP for the First Generation Day at Brookdale co-sponsored by our EOF Program. Club/Organization*Trip Name*Destination (City, State)*Trip Start Date* Date Format: MM slash DD slash YYYY Trip Start Time* : HH MM AM PM Trip End Date* Date Format: MM slash DD slash YYYY Trip End Time* : HH MM AM PM Requesting Member Name* First Last Requesting Member Email* Enter Email Confirm Email Your Club Position*PresidentVice PresidentTreasurerSecretaryOther E-Board PositionGeneral MemberAdvisor(s)*NameEmail Click the + button to add another advisorTrip Chaperone(s)*NameE-Mail Click the + button to add another chaperoneWho may attend? (Please check all that apply)* BROOKDALE Students Faculty/Staff Community Members Club/Org Members ONLY What is the purpose of travel? Please provide as much detail as possible.*How Does This Event Fit Into The Mission Of Your Organization?*Would you also like to propose this event to fulfill your Club/Org's Community Service Requirement?*YESNOOutside Agency (if applicable)Contact Person from Outside Agency First Last Contact Person Phone NumberContact Person E-Mail Facility/Hotel/Overnight Accomodations*Facility Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Facility Phone Number*Special Events/Activities Planned (please list the activity, date time, facility location and an emergency phone # if available)You can also upload this information as a seperate documentTravel Arrangements (Please check all that apply)* Airplane Airport shuttle Charter Bus College Van Train OTHER Please Note How Many and What Type of Room accommodations you Need: (ie, 2 doubles, or 1 single, 2 triples)QuantityType of Room Click the + button to add another type of roomDo you need a cash advance to travel?*YESNOPlease Note: cash advances are only available to Brookdale Employees, can take up to six weeks to process before a trip, and must be returned within five business days after a trip with itemized receipts.Total number of students travelling*Names of students participating (including name and phone number of emergency contact for each)*Student NameEmergency NameEmergency Phone # Press the + button to add another studentConference/Event Registration/Admission Cost per StudentTransportation Cost per StudentLodging Cost per StudentFood Cost per StudentPlease visit www.gsa.gov for per diem ratesMiscellaneous Cost per Student (Please explain cost(s) in detail)Total Cost per StudentTotal Student CostNumber above times number of students participatingTotal Number of Chaperones Travelling*Student Life & Activities will fund one chaperone for every ten students travelling.Conference/Event Registration/Admission Cost per ChaperoneTransportation Cost per ChaperoneLodging Cost per ChaperoneFood Cost per ChaperonePlease visit www.gsa.gov for per diem ratesMiscellaneous Cost per Chaperone (Please explain cost(s) in detail)Total Cost per ChaperoneTotal Chaperone CostNumber above times number of chaperones participatingWill you be applying to the SLB Finance Committee for funding?*YESNO$1.00 - $3500.00=60% funded by ASBCC; $3501-$7000.00=40% funded by ASBCC; more then $7000.00=$2800.00 funded by ASBCCTOTAL TRAVEL COST (answer 0 if none)*If you have other information to be considered, please upload a file here(Itinerary, Conference Schedule, etc...)
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