Off-Campus Request

Off-Campus Request Forms must be submitted 48 hours in advance of the requested off-campus time so that LSM Student Life Staff can make arrangements and be prepared. If you have an urgent request within 48 hours, please call the Student Life office at 612-879-9555 ext. 8.

Student's Name

First Name

Last Name

Adult Chaperone's Name

First Name

Last Name

Adult Chaperone's Phone Number

(###)

###

####

Adult Chaperone's Email

Date Requested for Pick-Up (at Guild-Memorial Hall)

YYYY

Time Requested for Pick-Up (at Guild-Memorial Hall)

Date Requested for Return (to Guild-Memorial Hall)

YYYY

Time Requested for Return (to Guild-Memorial Hall)

Reason for Leaving Campus