Hazelden Betty Ford Foundation Travel Request Form

Hazelden Betty Ford Travel Request Form
Are you the travel arranger?*
Travel Arranger Name*

First NameLast Name
Travel Arranger Email*
example@example.com
Traveler First Name*
Traveler Last Name*
Email*
Cell Phone Number*

Area CodePhone Number
CTS Training*

YesNo
Training Type*

BARR-4510.4605Clinical - 4520.4065Prevention Solutions – 4510.4620.55655Systems and Operations – 4530.4705Programming – 4510.4600Other
Business Reason for Travel:*
e.g. – Spring board of directors’ meeting
Actual Event/Business Purpose Dates*
XX/XX/XXXX - XX/XX/XXXX
Approving Manager (must be an official HBFF email address)*
xxxx@hazeldenbettyford.org
Business Unit/Cost Center to charge*
xxxx.xxxx
Does your trip require an airline ticket?*
Is this a multi-city trip
DESTINATION 1
Departing City (Airport)*
Destination City*
Travel Date for Departure*

MonthDayYear
Preferred Departure Time*

:HourMinutesAM/PM Option
Travel Date for Return*

MonthDayYear
Preferred Arrival Time*

:HourMinutesAM/PM Option
DESTINATION 2
Departing City (Airport)*
Destination City*
Travel Date for Departure*

MonthDayYear
Preferred Departure Time*

:HourMinutesAM/PM Option
Travel Date for Return*

MonthDayYear
Preferred Arrival Time*

:HourMinutesAM/PM Option
Special Requests
Please include any special requests regarding your flight. PRE TSA#: xxxxxxx Delta Sky Miles: xxxxxx American Airlines: xxxxxx
CAR RENTAL INFORMATION
Car rental needed?*
Car Pick Up Location*
Ex: Airport, Address for Car Rental Location
Car Pick Up Date*

MonthDayYear
Date
Car Pick Up Time*

:HourMinutesAM/PM Option
Car Drop Off Location*
Ex: Airport, Address for Car Rental Location
Car Drop Off Date*

MonthDayYear
Date
Car Drop Off Time*

:HourMinutesAM/PM Option
Have you completed the required training under HBFF Driver Safety and Fleet Management Program Policy?
“Distracted Defensive Driving” training is provided by HR and is available on ADP.
HOTEL INFORMATION
Do you need a hotel? *
Check In Date*

MonthDayYear
Date
Check Out Date*

MonthDayYear
Date
Hotel Location*
Address, City, State
Hotel Name*
EX: Hilton, Hampton
If additional hotel nights are needed please address in "Special Requests" below.
Special Requests
Please include any special requests regarding your hotel room. If you have a hotel loyalty number please add that here also.
Other Notes to Agency:
Please submit your form for processing.
Should be Empty:

Hazelden Betty Ford Travel Request Form