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Short Stay Away Trips and Repeated Use Facilities

The purpose of this form is to advise on Clery Reportable Geography which meet the following requirements:

Short-Stay "away" trips - College sponsored trips of more than one night for student travel. Include information about lodging and any classroom (other) space sponsored by the College.
Repeated Use - College sponsored travel that occurs more than once in any 365 day period (i.e. student group travels to New York every semester and stays at the same hotel each time.

Complete the following fields to report on these locations.

Name and contact information of person completing this form.

First Name:

Last Name:

Department:

Email Address:

Phone Number:

Name and contact information of the staff/faculty member responsible for this trip.

First Name:

Last Name:

Organization:

Organization Trip Name:

Email Address:

Phone Number:

Arrival Date:

Departure Date:

Exact name and address of the location where the students stayed (Leopard Hotel - 123 Main Street, NY 12345)

Did this organization use the exact location in the past?

Yes - In the last year
No - Have never stayed at this location or its been more than one year since last stay at this location

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