Travel Request Form

Global Health Community Engagement Award Travel
PLEASE NOTE:

Keep the $2000 limit of the award in mind. If your airfare is significantly less than $2000, you may use the remainder of the award for other travel expenses.

If your airfare is more than $2000 you may be responsible for reimbursing the Center for Global Health for the difference.

MGB only supports coach class airfare and any upgrades, including extra leg room seats, may require additional approval. 
Program Manager: Jenna Quinn
Jenna's Phone Number
Department Name
Billing Business Unit
Cost Center/Fund Number
TRAVELER INFORMATION

The following information is required for TSA compliance, Great Getaways internal records, reservation ticketing, and MGB Risk Management.

Traveler Name- Must match government ID that will presented to TSA
Last Name* / First Name* Middle
Traveler Mobile Phone Number
Area code and number
Email
example@example.com
Email (corrupted)
example@example.com
PASSPORT INFORMATION
For International Travel Only: For US Citizens passports must be valid for at least six months from expected return date to United States and have 2 blank pages not including the back two pages. For citizens of other countries please obtain the information from Embassy of any countries you plan to travel or connect through. Visa's and COVID-19 travel requirements are the responsibility of the traveler.
Passport Last Name / First Name Middle Name
Passport Document Number
Passport Issuing Country
Passport Expiry Date
Nationality
Birth Date

MonthDayYear
Gender (as it appears on your Passport or Government Issued ID)
Gender must match Government ID
TSA Pre✔ Known Traveler Number (KTN) GOES
Redress Control Number (redress number)
Departure City
*Please list City & State or Airport you prefer.
Arrival City
*Please list City and/or country you want to visit.
Departure Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Return Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Departure Time

:HourMinutesAM/PM Option
Preferred Return Time

:HourMinutesAM/PM Option
Seating Preference
Accessibility, special needs requirements, air and frequent flyer number, and requests?
*Please list any special needs requests or preferences
Seating Upgrade - cannot be billed to MGH unless authorized
Do you need multiple destinations?
Multi-Destinations
*Indicate what destinations you need.
Other Flight Details
Do you require accommodations?
Number of Rooms
*Please list the number of rooms needed for your reservation.
Room/Bedding Type
*Please select which bed/room type you prefer.
Preferred Hotel Brand
*If you have a preferred hotel brand, please list here.
Special Requests
*Please list any special requests you may have.
Signature
Click the Box
Should be Empty:

Global Health Community Engagement Award Travel