Travel Request – Specialists – Employee Resources

Department Head*
- Bledar Bisha
- Jonathan Fox
- Andrew Kniss
- Scott Miller
- Ben Rashford
- Peter Thorsness
- Christine Wade
Dept Head Email
Name*
First Last
Email*
Activity / Meeting Title*
Origination Location*
Destination Location*
Departure Date*
Date Format: MM slash DD slash YYYY
Departure Time*

HH :

MM
Return Date*
Date Format: MM slash DD slash YYYY
Return Time*

HH :

MM
Total Hours Requested*
Additional Individuals*
Will additional individuals be joining you at the destination?
- Yes
- No
Preventing COVID-19 Transmission*
If you selected "Yes" for Additional Individuals, please provide the steps that will be implemented to prevent transmission of COVID-19
Activity Categories*
Select one or more of the following categories of mission critical Extension activities.
- Extension Associate Directors and State 4-H Program Coordinator traveling to county extension offices to provide administrative support and supervision of field-based extension personnel.
- Extension administrators (Director and Associate Directors) traveling to coordinate with County Commissioners in budget development, personnel management, facilities and UW engagement in their county.
- State Extension Specialist’s (from academic departments and State 4-H office) travel from Laramie to support and contribute to the research and educational programs of field-based extension educators.
- UW Extension personnel traveling from Laramie and other locations in Wyoming to support county and state 4-H Youth Development events.
- UW Extension personnel traveling from Laramie to support fundraising events and donor engagement for the Wyoming 4-H Foundation, College of ANR and UW.
- UW Extension personnel traveling from Laramie to county extension offices to provide technology support, distribute teaching materials, or provide administrative support for extension events.
- UW Extension Area Educators traveling within their assigned area (5 counties) of responsibility to discharge the duties of their positions.
Justification to be considered Mission Critical Travel*
COVID-19 Travel Requirements*
You agree to the following:
- Select All
- Has been allowed to decline participation in the interest of protecting your health.
- Will purchase food to-go, when possible, to maintain social distancing.
- Will utilize gloves when purchasing fuel.
- Will utilize proper PPE (masks, gloves, face shields).
- Will wash hands frequently and/or utilize hand sanitizer.
- Will disinfect any equipment used after each use.
- Will inquire of overnight accommodations to ensure proper cleaning has occurred.
A medical screening form has been completed and is filed in my office.*
- Yes
The Medical Screening Form can be obtained here.