Ethics Council | Travel Approval Request Form

Last Name *

First Name *

Middle Initial

Address *

City *

State *

Zip *

Phone Number(s) *

If more than one, add a comma(,) after each phone number

Email Address(s) *

If more than one, add a comma(,) after each email address

Official Job Title *

County/District *

Travel Dates *

Date(s) of conference, seminar, meeting, event, etc. *

Destination *

What individual or organization will be providing the funding for this travel? *

What is the purpose of your travel? (Check all that apply) *

Educational

Public official event

Public policy discussion

Enhancement of your knowledge or skills related to your duties.

Other

Please explain how this travel relates to your official duties. Include any conferences, seminars, meetings, or other events you plan on attending or participating in. *

Are you attending the event as a(n): (check all that apply) *

Attendee

Speaker

Will this event be attended primarily by public officials? (check one) *

Yes

No

Hospitality/Entertainment: (Ex: The Phantom of the Opera musical at the Majestic Theater)

For the following section, please list, to the best of your current knowledge, hospitality or entertainment you plan to use or participate in during travel.

Is this hospitality/entertainment included as part of the base event registration fee? *

Yes

No

Estimated total value *

Please include the estimated total value of your travel, not including the cost for any hospitality or entertainment not included as part of the base registration fee. If you are unsure of specific values because lodging/transportation/etc. have not been finalized, please include your estimated budget. Please include numerical values ONLY. Entering text will prevent your request from being properly submitted.

Have you previously attended this event or similar events in the past two (2) years? Please list the date and purpose of each.

Yes

No

Have you submitted any other travel requests to the Council in the past two years? Please include the date and purpose of the travel request and if it was approved or denied.

Yes

No

Please include any additional information you feel is pertinent to the Council's assessment of this request.

Please note that if you receive approval for this travel, you may not be prosecuted, assessed a civil penalty, or otherwise disciplined for accepting the travel and travel-related things of value, regardless of whether approval is later withdrawn, provided that the travel occurs prior to the withdrawal of approval.

I affirm that the information I have provided is true and complete to the best of my knowledge.

By checking this you are consenting to the terms above. *

Travel Approval Request Form

Traveler's Information

Traveling Details

Submission