Clery Act Student Travel Form

Name of person submitting form:

Group Name:

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

Name:

Title:

Department:

Phone:

St. Bonaventure University Email:

TRAVEL DATES

Check-In Date:

Check-Out Date:

How many nights did you stay?

LODGING FACILITY INFORMATION

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

Lodging Facility Name:

Street Address:

City:

State:

Zip:

Specific floor(s), room number(s), or unit number(s) occupied:

THIS TRIP IS:

a one-time trip
repeated each semester
repeated annually
other

If you selected “other” above, please explain:

If trip is repeated, our group:
always stays at the exact same lodging facility uses various lodging facilities with each trip.

Please select one (1):

To the best of my knowledge, no crime was committed in this place of lodging during the dates of our stay.
During the time period of our stay, the following crime was reported to have occurred at this place of lodging.

Please include as much detail as possible regarding the crime, to include date and time of crime, type of crime, whether or not victim is student or non-student of St. Bonaventure University.

Generate New Image

Type the code from the image