Clery Pre-Travel Form Student Overnight Travel to Off-Campus Locations Please submit this form within 30 days prior to travel. Do NOT enter student names, phone numbers, or other student information on this form. To prevent duplicate entries, this form should be completed by the LMC employee who initiated the travel and not by students. Enter one submission per location, NOT one submission per student. If you have any questions, or submit any errors, please email ASPQ: ASPQ@lakemichigancollege.edu Clery Overnight Travel FAQS Question Title * 1. DATE OF FORM SUBMISSION: Today's date: Date Question Title * 2. FACULTY/STAFF CONTACT INFORMATION: Faculty/Staff Name: (This is the name of the person submitting this form. Student name/information should not be submitted) Department: Faculty/Staff Email: (Must be @lakemichigancollege.edu) Question Title * 3. Are you or someone traveling with you currently trained as a Campus Security Authority (CSA)? (If you don't know who is currently trained as a CSA, contact ASPQ@lakemichigancollege.edu) Yes No Question Title * 4. Please provide all names of trained CSAs traveling and their training dates: (FName, LName, MM/DD/YYYY) Question Title * 5. LODGING CATEGORY: Please select lodging category below: Hotel/Motel Airbnb Other (please specify): Question Title * 6. LODGING/LOCATION INFORMATION:(Do NOT put multiple addresses on one form) Lodging/Location Name: Street Address: Address 2 City: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Phone Number: Question Title * 7. Number of students traveling: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Question Title * 8. Number of room reservations: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Question Title * 9. LODGING CHECK-IN/CHECK-OUT INFORMATION: Check-in date/time: Date Time AM/PM - AM PM Check-out date/time: Date Time AM/PM - AM PM Question Title * 10. Were you required to pay for parking during your stay? Yes No Question Title * 11. Law enforcement agency having jurisdiction over the location listed above:(Note: It's usually best to contact the front desk and ask which police agency responds to their address) Agency Name: Street Address: Address 2 City: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Phone Number: Question Title * 12. Please enter any additional travel information you may have that is not captured above: SUBMIT FORM
