NCSSM-Durham: Student Travel Permission Form
Once this form has been submitted, a Student Life staff member will call the legal guardian of the student to confirm the details for final approval. You can contact the Bryan desk proactively or if you have any questions.

Please only fill out this form if your student is being picked up by someone other than a legal guardian (as listed in Blackbaud) to travel more than 30 miles from campus, overnight, or miss curfew.

If your student is being picked up by a legal guardian (as listed in Blackbaud), and will miss curfew or be gone overnight, simply come to the Bryan Desk with your student to sign out; you do NOT need to fill out this form.

Para ver el formulario en Español, haga clic aquí:
https://goo.gl/forms/F4UMOVGBI0jBHntZ2

点击此处查看中文表格:
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Student's name: *
Student's 'home' campus: *
Which program is the student enrolled in? This helps us find their family's contact information more quickly.
I give permission to my student for the following: *
My student will be picked up by: *
Please list a specific individual.  We will check ID at the time of checkout. Reminder, if you are a legal guardian for this student, you do NOT need to fill out this form.
Date of travel and time of departure: *
MM
/
DD
/
YYYY
Time
:
Date and time of anticipated return to campus: *
MM
/
DD
/
YYYY
Time
:
Destination *
Please be as specific as possible, e.g., a building and room number at UNC instead of just "UNC" or "Chapel Hill".
Other NCSSM students traveling with this student:
Please note that approval of this student travel permission form submission does not automatically grant permission for all students listed in your response here.
Your name: *
Best way of reaching the student's legal guardian(s) to discuss this request: *
We will call the numbers that are listed in Blackbaud so please make sure that those are up-to-date.
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