International Travel Approval Form

Date of Request: Click here to enter a date.

Traveler: Click here to enter text.

Passport #: Click here to enter text. Expiration Date: Click here to enter text. Country of Issue: Click here to enter text.

Destination(s): Click here to enter text.

Travel Dates: Click here to enter a date. to Click here to enter a date.

Event Dates: Click here to enter a date. to Click here to enter a date.

Purpose of International Travel: (Must demonstrate mutual benefit to traveler and institution. Attach documentation if needed)

Click here to enter text.

Estimated Costs:

Airfare
Hotel	nights	X	per night =	0.00
Registration fee
Car Rental	days	X	per day =	0.00
Mileage	miles	X	0.42	per mile =	0.00
Other expenses (Taxi, Parking, Luggage, Rental Gas, etc.)
Omit
Estimated Total Cost	0.00

Will you charge airfare to a TCard? ☐Yes ☐ No

If yes, attach proposed itinerary from airline or agency.

Reason for selecting Hotel:	Choose an item.

Method of paying the registration: Choose an item.

Please attach registration form if possible, or web address.

Will you require meals for all days?	☐Yes	☐ No

Will you require a travel advance?	☐Yes	☐ No

Cost Center(s) or Fund/Org to be charged: Click here to enter text.

Is traveler requesting any annual leave in conjunction with this trip? ☐ Yes ☐ No

If yes, please give dates: Click here to enter text.

Is this a recurring trip?	☐Yes ☐ No

If yes, describe: Click here to enter text.

Is there a Travel Warning or Travel Alert issued for this destination? ☐ Yes ☐ No

http://travel.state.gov/travel/cis_pa_tw/pa/pa_1766.html

http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html

Will any federal funds be used for this travel?	☐ Yes ☐ No

If yes, I certify that I am in compliance with the Fly America Act. ☐ Yes	☐No

Reference: http://www.gsa.gov/portal/content/103191

Will traveler carry any items subject to Export Controls or items that require an Export Controls License?	☐ Yes ☐No

If yes, describe in detail the items(s): Click here to enter text.

If yes, I certify that I am in compliance with Export Controls regulations. ☐ Yes ☐ No

Reference: http://www.access.gpo.gov/bis/ear/pdf/indexccl.pdf

Will you request an international plan for phone and data?	☐Yes ☐ No

I am aware that I am personally responsible for costs incurred if the proper international phone/data plan has not been requested prior to travel.	☐Yes	☐ No

Contact information while you are abroad:Click here to enter text.

Who should be contacted in an emergency? Click here to enter text.

Signature of Traveler: ________________________________________ Date: ____________

Approved: _______________________________ Date: ________ Unit Head/Department Head Not Approved: _____________ Date:__________ Reason: _____________________________ ____________________________________________________________________________