Global Experience Office Off-Campus Travel Proposal Intake Form

Submitter’s Name: *

Submitter’s Email: *

Department/Office: *

Position: *

Group Leader’s Name (if different than submitter):

Group Leader’s Email:

Name of Sponsoring School/Department/Office or Organization *

Travel Type *

Credit Bearing/Non-Credit Bearing (Check Box) *

Credit

Non-Credit

Currently, what country are you physically present in? *

By providing the information requested in this form, you are consenting to WPI’s use of the provided information for the purpose for which the form is being used. See Privacy Policy Below.

Travel Details

List the program location countries/US states and cities that you will be visiting:

	Country/US State	City
1	Country/US State	City
2	Country/US State	City
3	Country/US State	City

Departure Date * +

Returning Date * +

If this is an established WPI Project Center, please explain further details about the proposed project:

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Refund Statement: Refunds are issued at the discretion of the Event Coordinator or Department Manager. For inquiries regarding refunds please contact the managing department of your event/program, or email bursar@wpi.edu.