CLERY ACT STUDENT TRAVEL FORM
This form is to be completed for any College-related overnight travel, domestic and overseas, that includes students such as athletics, academics, clubs/organizations, etc. The federal Clery Act law requires that institutions track what is known as “non-campus” property, and report certain crimes that occur at those locations. Non-campus property includes property that SLU controls on a short-term basis if there is a written agreement for the property, the property is frequented by students, and it is used to further SLU’s educational mission. SLU is required reach out to the local law enforcement agencies with jurisdiction over non-campus property and request crime statistics for the dates and times when SLU controls the space. SLU must provide the statistics, if any, to the federal government and publish them in the Annual Security and Fire Safety Report.

Please submit this form AFTER your travel to ensure you have complete information, including specific rooms/suites occupied. If you have questions, please contact Michael Parkinson, Clery Compliance Coordinator, at 314-977-7129 or michael.parkinson@slu.edu.

Today's Date *
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Group Name: *
Your answer
Name of person submitting this form: *
Your answer
TRAVEL CONTACT INFORMATION
I understand that I am a Campus Security Authority (CSA) for this trip and must report to the SLU Department of Public Safety in a timely manner any crimes brought to my attention. To submit a crime please click on the following link : https://docs.google.com/a/slu.edu/forms/d/1KPLg_KsktYW9rpNt7ZN42j6Zks1CLifMI-Y4_Hp-LjU/edit?usp=drive_web
Name (CSA in charge of the group) *
Your answer
Title: *
Your answer
Department: *
Your answer
Phone: (xxx) xxx-xxxx *
Your answer
Email address: *
Your answer
Travel Dates
Check-in-Date: *
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DD
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YYYY
Check-out-Date *
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LODGING/FACILITY INFORMATION
If group is staying at more than one lodging facility, please complete a separate form for EACH facility. Additionally, along with lodging, if during the trip the University "controls" any additional spaces (classrooms, meeting rooms, team meal spaces, etc.) please include in the section below marked with #
Name of the facility: *
Your answer
Street address: *
Your answer
City, State, Zip, Country: *
Your answer
# Specific floor(s), room number(s), or unit number(s) occupied *
Your answer
The trip is: *
If you selected "other" above, please explain:
Your answer
If trip is repeated, our group: *
LAW ENFORCEMENT AGENCY INFORMATION (if known)
The University is required to collect and report crime statistics from local law enforcement agencies regarding certain non-campus lodging facilities or other controlled spaces where SLU students are housed or spaces they use during University sponsored overnight student travel.

It is critical this information is provided by the CSA's who are travelling with students overseas.

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s):
Your answer
Address:
Your answer
City,State, Zip Code, Country
Your answer
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