1. Dillard University - Office of Facilities Management
Transportation Request Form
Please complete and forward to the Office of Facilities Management or fax this form to (504) 816-4833.
This form must be received five (5) business days prior to the requested date of transportation.
TRANSPORTATION SERVICES WILL BE PROVIDED FOR OFFICIAL UNIVERSITY BUSINESS ONLY.
PLEASE SUBMIT DOCUMENTATION THAT YOUR REQUEST IS UNIVERSITY RELATED. REQUESTS ARE SUBJECT TO AVAILABILITY.
Requested by: Phone #: /
Vehicle type: p Car p Van p Shuttle Bus
Department/Group:
Departure Date: Return Date:
Departure Time: p AM p PM Return Time: p AM pPM
Pick-Up Location: Pick-Up Location:
Drop-Off Location: Drop-Off Location:
Destination:
Purpose of Trip:
Passenger's Name(s):
Requestor's Signature: Date:
Authorizing Signature: Telephone #:
(Please Print or Type)
x Approved p Denied Service Charges:
Driver Assigned: Car $30.00 per day
Vehicle License #: Van $40.00 per day
Beginning Mileage: Shuttle $250.00 per day
Ending Mileage: # Miles x $0.55
Approval Signature: Subtotal for Mileage: $-
Approval Date: TOTAL COST: $-
Please submit a standard University requisition for payment or make checks payable to Dillard University.