Faculty/Staff Led Short-Term Trip Approval Form
This form must be filled out at least 18 months before the trip date.
Name
*
First Name
Last Name
Department
Email
example@example.com
Anticipated# of students. Note: There is a limit of 13 students per trip.
Course Name and Number.
Semester the field experience will be offered.
Proposed Destination
Trip start date
-
Month
-
Day
Year
Date
Trip end date
-
Month
-
Day
Year
Date
Project Description (500 word maximum) Please include a general description of the program.
Learning goals and measurable student outcomes of the trip.
Describe how this program supports Rockford University’s mission:Educating students to lead responsible lives through a curriculum grounded in liberal arts learning and complemented by professional and practical experience, preparing them for fulfilling lives, careers, and participation in a modern and changing global society.Please explain:How the program promotes global awareness and intercultural competenceHow students will engage in responsible citizenshipHow experiential learning complements classroom instruction
Semester schedule for the course linked to the field experience course. For example, will you be meeting every week, bi-weekly, once a month etc.
Semester the field experience course will be offered.
Please Select
Fall
Spring
Budget Breakdown
Rows
Amount (USD)
Justification
Transportation:
Airfare
Transportation:
Local
Transportation:
Vehicle Rental
Transportation:
Gas
Transportation:
Other (example car mileage)
Lodging
Museum Fees
Meals
Registration (if it is a conference/ workshop etc.)
Other: Passport/Visa etc.
Travel Insurance
Other: Please Enter
Other: Please Enter
Other: Please Enter
Total Cost
Submit
Should be Empty: