FOREIGN TRAVEL CHART

Name: Page of

Dates: Itinerary: Lodgings: Travel Companions: Costs: Purpose:

FOREIGN TRAVEL

Instructions: Please fill out the categories as completely as possible. Please complete one page for each trip.

Dates:

The dates of arrival and departure.

Itinerary: Country visited, city in which you stayed overnight. Include day trips to places such as Canada and Mexico.

Lodgings: Names of the hotel, youth hostel, B&B, camping area, etc. of the places you stayed. If stayed in a private residence,

provide the name of the person you visited and the address.

Travel Comp: Who did you travel with, what is their citizenship, and what is their relation to you, such as friend, roommate, or

spouse?

Costs:

Not how much, but who paid the costs. Example: self, parents, professional organization, business, foreign entity.

Purpose: Vacation, education, family visit, participate in a conference, or others.

Privacy Act 5 U.S.C.552a requires that federal agencies inform whether the disclosure is mandatory or voluntarily, by what authority such information is solicited, and what uses will be made of the information. Authority for soliciting your SSN is Executive Oder 9497, Nov. 43. Your personal data will be used to identify you precisely when required. Although disclosure is not mandatory, failure to do so may impede processing.

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