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TRAVEL AUTHORIZATION AND EMERGENCY CONTACT FORM

TRAVEL RELATED TO OUTSIDE WORK FOR PAY SHOULD NOT BE AUTHORIZED BY THE UNIVERSITY SECTION A: TRAVEL AUTHORIZATION Name:
(Last) (First) (ZPID or MSU NetID#)
This section must be completed prior to departure.

SECTION B: ESTIMATED TRIP COSTS Airfare Lodging Ground Transport Meal Per Diems / M&IE Program Expenses Student Related Expenses Other

Email:
Visa Type

Department: Dept Addr: Check One: Check One:

FISHERIES & WILDLIFE NATURAL RESOURCES BUILDING, 480 WILSON ROAD, ROOM 13 US Citizen
Faculty/Staff

Resident Alien Graduate

NonResident Alien Undergraduate

Other

Total Estimate $

Departure Date 4/11/14

Return Date 4/13/14 Big Bay, MI

Destination(s) (City, State and Country required)

Account Number(s) to be charged: Purpose of Travel (Check all that apply and fill out description): XX Conference/Meeting International Programs External Relations/Development Teaching/Outreach Research Recruitment Team Other

Reimbursement Limited to: $ Conference Fees Amount: $

Conference Fee Paid by ProCard: Yes Car Rental: Yes Airfare direct billing : Yes

Travel Reimbursed by: MSU Funds Description: 2014 Midwest TWS Student Conclave

XX

Non-MSU Funds

Contracts & Grants Signature (Req'd for International)

SECTION C: MOTOR POOL - CAR USAGE This section is to be filled out when authorizing traveler to use a Motor Pool Vehicle. Name(s) of Additional Drivers: 1) 2) 3) 4) Primary Driver:

SECTION D: EMERGENCY CONTACT INFORMATION - (AS REQUIRED BY COLLEGES/MAJOR ADMINISTRATIVE UNITS (MAU)) FOR INTERNATIONAL TRAVEL: International travel data provided from this section should be keyed into the Travelers Database (excluding MSU study abroad) by personnel designated in each participating college/unit. Enter "N/A" for missing information. FOR DOMESTIC TRAVEL: This section may be used for domestic travel. However, the information should not be entered into the Travelers Database. 1. Emergency Contact Information (spouse, etc.) Name 2nd Emergency Contact Information Name 2. Supervising Faculty Member Information (Graduate/Undergraduate Students Only) Name 3. Destination Information First Travel Location: Dates: 04/11/14 - 04/13/14 Hotel/Host: Bay Cliff Health Camp, Big Bay, MI Address: 4175 Baycliff Dr, Big Bay, MI 49808 Phone: (906) 345-9314 Host/Colleague Email: Second Travel Location: Dates: Hotel/Host: Address: Phone: Host/Colleague Email: Phone Email Phone Email

Phone

Email

Third Travel Location: Dates: Hotel/Host: Address: Phone: Host/Colleague Email: Will the traveler be checking email while in travel status? SECTION E: AUTHORIZATION SIGNATURES Yes Travel Authorization: Motor Pool Vehicle: No Yes-regularly XX Yes-periodically

Fourth Travel Location: Dates: Hotel/Host: Address: Phone: Host/Colleague Email: Yes-infrequently No

Dean (including Assoc. & Assist. Dean), Director, Chairperson, or Organization Level Budget Officer

Print Name

Date

Department Contact: Email:

Marcia Baar baar@msu.edu Phone #: 355-4478


Rev 11/10 New 9/2004

MSU is an affirmative-action, equal-opportunity employer.

Please retain original travel authorization with original signatures in department.