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926 E. Dunklin Street
Jefferson City, MO 65102
Ph: (573) 681-5473
Fax: (573) 681-5474
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_______________________ ________________________ ____________________ ________________
Last Name First Name Nickname LU Student ID
____________________________________________________ __________________________________________
Email Phone #
Country of Origin ________________________________________
I am currently in the following city and country:__________________________________________________________________
I am traveling to Lincoln University by (please check all that apply):
_____Air _____Train _____Car _____Bus _____Shuttle
My travel itinerary is as follows. Please include all departure cites of departure and arrival, date, times, flight numbers, etc.
First Travel Plan
Departure City
Date & Time of Departure
Method of Transportation (check all
that apply)
Air
Train
Car
Bus
Shuttle
Arrival City
Date & Time of Arrival
Second Travel Plan
Departure City
Date & Time of Departure
Method of Transportation (check all
that apply)
Air
Train
Car
Bus
Shuttle
Arrival City
Date & Time of Arrival
Third Travel Plan
Departure City
Date & Time of Departure
Method of Transportation (check all
that apply)
Air
Train
Car
Bus
Shuttle
Arrival City
Date & Time of Arrival
FOR ISC USE ONLY:
Received on __________________________ by____________________________ Student File Updated on: ___________________________
(Month/Day/Year) (ISC advisor’s name) (Month/Day/Year)
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