Please fill out to place your reservation for the OGE Van. Reservations are available on a first-come first-serve basis and someone from Global Engagement will contact you soon regarding your reservation. Use of the OGE van costs $0.58 per mile. Requesting Department/Organization Purpose of Trip Departure Date Departure TIme Return Date Return Time UNCP Contact Person Contact Email Address Contact Phone Number Destination Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Driver Information First Name Last Name Driver's Cell Phone Driver's License Number Fund to be Charged Account to be Charged 22731-Student Travel 22714- Faculty/Staff In-State Travel 22715- Faculty/Staff Out-of-State Travel Fund Manager Agreement I understand that this agreement depends upon the availability of the International Programs Van and that a staff person in that office will contact me to confirm whether the van has been reserved for my group. I agree that my department/organization will pay International Programs $0.58 per mile from the fund listed above. Drivers agree to abide by the university's Vehicle Use Policy (http://www.uncp.edu/about-uncp/administration/departments/facilities-operations/vehicle-request/policy-vehicle-use) Drivers are asked to ensure that the passengers clean the van when they return to UNCP. Please be sure to return the van at least as clean as you receive it. At the time of confirmation, International Programs will send the department an emailed copy of the van use agreement. Please bring the signed agreement/ check-out form with you when you come to take the van. By signing this form, I certify that I am signing this form on my own behalf and I have agreed to submit this application by electronic means. Signature Sign above Leave this field blank