Center for Global Engagement - Van Request Form

Today's Date Today's Date * / MM / DD YYYY
Requestor's Information
Requestor's Name Requestor's Name * First Last
Email *
Phone Phone * - ### - ### ####
Requestor's Department *
Trip Information
Start Date of Van Use Start Date of Van Use * / MM / DD YYYY
Return Date of Van Return Date of Van * / MM / DD YYYY
Driver's Name Driver's Name * First Last
Has the driver completed the safety course administered by Risk Management? *

Has the driver completed the safety course administered by Risk Management? Yes No
Do you certify that this travel is for official university business?

Do you certify that this travel is for official university business? Yes No
Trip Destination *

In-state travel only
Approximate Round-Trip Mileage *
Expected Number of Passengers, including driver *
Purpose of Travel *
Key Pick-Up & Return

Keys must be picked up from Price Memorial 218 on the Dahlonega campus.
Pick-Up Date Pick-Up Date * / MM / DD YYYY
Pick-Up Time Pick-Up Time * : HH MM AM/PM
Return Date Return Date * / MM / DD YYYY
Return Time Return Time * : HH MM AM/PM
Billing & Approval Information

A department chair/budget manager approval and account number are required prior to key pick-up for the purpose of allocating gas charges to the appropriate account.
Department/Account Name *
Charging Account Number String *
Department Chair/Budget Manager Department Chair/Budget Manager * First Last