Travel Request Form

If you have any problems filling out this form, please contact us at (415) 403-1448

Traveler Form

REQUESTER INFORMATION

First and Last Name *

Campus/Auxiliary Name *

Email Address *

1. TRIP/TRAVELER INFORMATION

Traveler Last Name: *

Traveler Middle Name:

Traveler First Name: *

Traveler Email: *

If others: Provide relationship to employee / CSU

Departure Date *

Return Date *

Personal Travel Dates (if applicable):

Destination (Country): *

City/Town and Region: *

Comments:

Project #/ Account #/ Dept #:

Other ID #/ Fund/ Program/ Class:

Notice 1

Additional Travelers - If there are 5+ travelers, please upload all traveler information via PDF or Word document in the space provided below

2. TRAVELER #2 INFORMATION

Traveler #2 Last Name:

Traveler #2 Middle Name:

Traveler #2 First Name:

Traveler #2 Email:

If others: Provide relationship to employee / CSU

Comments:

3. TRAVELER #3 INFORMATION

Traveler #3 Last Name:

Traveler #3 Middle Name:

Traveler #3 First Name:

Traveler #3 Email:

If others: Provide relationship to employee / CSU

Comments:

4. TRAVELER #4 INFORMATION

Traveler #4 Last Name:

Traveler #4 Middle Name:

Traveler #4 First Name:

Traveler #4 Email:

If others: Provide relationship to employee / CSU.

Comments:

5. TRAVELER #5 INFORMATION

WILL TRAVELER(S) BE RENTING A VEHICLE WHILE TRAVELING ABROAD? IF NO, PLEASE ENTER 0. IF YES, HOW MANY VEHICLE RENTALS?

6. HIGH HAZARDOUS/WAR COUNTRY INFORMATION

Are any of the destinations on the High Hazardous list?

Are any of the destinations on the War Risk list?

Are any of the destinations on US travel warning list (Level 3 or Level 4) ?

Notice 2

If any of the above boxes are checked, please attach Campus President/Designee approval.

7. ATTACHMENTS - Maximum of 3 files/documents

Attach supporting documents and/or participant list:

Notice 3

Please Note: This request will be automatically emailed to the Program Administration Staff at Alliant Insurance, Inc. If this request should be on a "rush basis" you should also contact either of the following individuals to be sure they received your request: Van Rin at vrin@alliant.com / (415) 403-1408 or Stacey Weeks at sweeks@alliant.com / (415) 403-1448.