Travel Request As a reminder, it is current UW Policy that travel is restricted to one person per vehicle. Supervisor*Kelly CraneJohnathan DespainJeff EdwardsBridger FeuzDavid KetoMandy MarneyMindy MeuliSupervisor 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 AM PM Return Date* Date Format: MM slash DD slash YYYY Return Time* HH : MM AM PM Total Hours Requested*Additional Individuals*Will additional individuals be joining you at the destination?YesNoPreventing COVID-19 Transmission*If you selected "Yes" for Additional Individuals, please provide the steps that will be implemented to prevent transmission of COVID-19Activity 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.