Student Travel Authorization Form

Please complete the following form as completely as possible.

Contact Rochelle.Robinson@wwu.edu with questions.

Required fields are marked with an asterisk (*).

Purpose of Trip

Comments

Link to Conference Website

Are you a current member if this organization?

Yes

Yes, but I need to renew

No

Trip Information

Departure Location

Departure Date

Estimated Departure Time

Planned Destination

Return Date

Estimated Return Time

Method of Transportation

Private Vehicle

Air

Bus

Train

Rental Car

Travel Justification

How does this travel relate to your education at Western?

Describe the expected benefits:

Travel Funding

Estimated Cost of Trip

Registration Cost

enter '0' if none

Please list any additional grant funding

e.g. Ross Travel Grant - $500

Additional Comments from Traveler

I agree to provide a personal statement and/or photo relaying my conference experience to the Department of Psychology when I return, to be used on departmental social media platforms, the annual newsletter, and at events (e.g., PsychFest).

Student Travel Authorization Form

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Student Travel Authorization Form