Student Life & Activities Travel/Off-Campus Community Service Proposal

Club/Organization*

Trip Name*

Destination (City, State)*

Trip Start Date*

Trip Start Time*

: HH

MM

Trip End Date*

Trip End Time*

: HH

MM

Requesting Member Name*

First Last

Requesting Member Email*

Enter Email Confirm Email

Your Club Position*

Advisor(s)*

Name	Email

Click the + button to add another advisor

Trip Chaperone(s)*

Name	E-Mail

Click the + button to add another chaperone

Who 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?*

YES
NO

Outside Agency (if applicable)

Contact Person from Outside Agency

First Last

Contact Person Phone Number

Contact Person E-Mail

Facility/Hotel/Overnight Accomodations*

Facility Address*

Street Address Address Line 2 City 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 document

Travel 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)

Quantity	Type of Room

Click the + button to add another type of room

Do you need a cash advance to travel?*

YES
NO

Please 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 Name	Emergency Name	Emergency Phone #

Press the + button to add another student

Conference/Event Registration/Admission Cost per Student

Transportation Cost per Student

Lodging Cost per Student

Food Cost per Student

Please visit www.gsa.gov for per diem rates

Miscellaneous Cost per Student (Please explain cost(s) in detail)

Total Cost per Student

Total Student Cost

Number above times number of students participating

Total Number of Chaperones Travelling*

Student Life & Activities will fund one chaperone for every ten students travelling.

Conference/Event Registration/Admission Cost per Chaperone

Transportation Cost per Chaperone

Lodging Cost per Chaperone

Food Cost per Chaperone

Please visit www.gsa.gov for per diem rates

Miscellaneous Cost per Chaperone (Please explain cost(s) in detail)

Total Cost per Chaperone

Total Chaperone Cost

Number above times number of chaperones participating

Will you be applying to the SLB Finance Committee for funding?*

YES
NO

$1.00 - $3500.00=60% funded by ASBCC; $3501-$7000.00=40% funded by ASBCC; more then $7000.00=$2800.00 funded by ASBCC

TOTAL TRAVEL COST (answer 0 if none)*

If you have other information to be considered, please upload a file here

(Itinerary, Conference Schedule, etc...)

Student Life & Activities Travel/Off-Campus Service Proposal