IMSE Student Travel Authorization Form

If you are traveling for professional reasons, please complete this form AT LEAST 2 weeks in advance of your travel.

Name(Required)

First Last

University Email(Required)

University ID Number(Required)

Student Status(Required)

Undergraduate

Graduate

Major Professor's Name(Required)

First Last

Major Professor's Email(Required)

Faculty Supervisor/Advisor's Name(Required)

First Last

Faculty Supervisor/Advisor's Email(Required)

Did you apply for the Professional Advancement Grant (PAG)?(Required)

Yes

Already received for a prior trip

Departure Date(Required)

First day of travel

Return Date(Required)

Last day of travel

Where are you going? (City, State)(Required)

Why are you going? (Justification of Travel)(Required)

Estimated Travel Expenses(Required)

Comments/Questions