Loyola University Maryland

Center for Community, Service, and Justice

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Transportation
Transportation Request

Transportation Request

All fields marked with an * are required.

Contact Information

(for the person completing the form)

First Name:

Last Name:

Preferred Name:

Cell Phone:

Email:

This email will be used for all approval notifications.

I am the primary driver:

Yes
No

Driver Information

Today's Date:

Primary Driver's First Name:

Primary Driver's Last Name:

Primary Driver's Preferred Name:

Primary Driver's Cell Phone:

Primary Driver's Email:

Include Primary Driver's Email Address for Approval Communication Emails?*

Yes
No

Alternate Driver's First Name:

Alternate Driver's Last Name:

Alternate Driver's Preferred Name:

Alternate Driver's Cell Phone:

Alternate Driver's Email:

Include Alternate Driver's Email Address for Approval Communication Emails?

Yes
No

Additional Drivers' Names, Cell Numbers or Email:

Number of passengers (including the driver):

Baggage (if applicable):

Service-Learning Only

Course Name:

Professor's Name:

Vehicle Departure/Return Dates

Proposed Use * (must be for Community Service or Service-Learning through CCSJ):

Community Service
Service-Learning
CCSJ Related Retreat or Conference

Is this a one-time use or recurring use?

One-time
Recurring

If one-time, departure date:

If one-time, return date:

If recurring, departure and return dates:

Use this field for recurring vehicle Departure/Return Dates (Please DON'T just write "Every Tuesdays" or "Every Thursdays", but specify the dates, and separate them by "comma", i.e. 11/5, 11/12, 11/19, etc. Make sure you skip the holidays or breaks dates)

Departure Time:

Please specify AM/PM and consider travel time.

Return Time:

Please specify AM/PM and consider travel time

Name of community partner organization:

Name of the destination (if different from community partner):

Address of the destination:

Vehicle Request

Please indicate how many vehicle(s) you need.

Auto (max. 5 passengers):

Mini-van (max. 7 passengers):

Handicapped Van:

Additional Comments

Please enter any additional comments:

4501 N. Charles Street, Baltimore, MD 21210
410-617-2000 | Weather Line: 410-617-2223