Clery Act Student Travel Form

This form is to be completed for any College-related overnight travel that includes students such as athletics, academics, clubs/organizations, etc. The form is also available in print-format at www.uvawise.edu/compliance. **NOTE: Please submit the form AFTER your travel to ensure you have complete information, including specific rooms/suites occupied.** If you have questions, please contact Stephanie Shell in the Office of Compliance & Conduct at 276-328-0216 or stephanie.shell@uvawise.edu.

TRAVEL CONTACT INFORMATION

**I understand that I am a Campus Security Authority (CSA) for this trip and must report to Campus Police in a timely manner any crimes brought to my attention.**

TRAVEL DATES
LODGING FACILITY INFORMATION

Note: If group is staying at more than one lodging facility, please complete a separate form for EACH facility.

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