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Simple Travel Certification Form Free Download
Simple Travel Certification Form Free Download
SSC-November 1, 2015
Travel Certification Form
Certification of Personal Responsibility with regard to University-related Travel
For use by Non-Employee Students and Interview Candidates only
Form must be completed prior to travel and must be attached to each Travel Expense Claim
LAST NAME (print): FIRST NAME (print):
1) I hereby certify that I will familiarize myself with and adhere to CSU and SSU Travel Policies and
Procedures ( prior to undertaking travel on University
business. I understand that this includes timely submission of expense claims.
2) I hereby certify that prior to each trip, I will obtain the approval of the host department.
3) I hereby certify that prior to any international travel, I will obtain approval in writing from the President of
the University. In addition, I will purchase international insurance using the Foreign Travel Insurance Program
(FTIP) ( no less than 30 days before
departure through the Seawolf Service Center, and last, I will sign-up for the Smart Traveler Enrollment Program
(STEP) at the U.S. Department of State’s website (
4) In accordance with State Policy, I hereby certify that when driving a personal, state, or rental vehicle on
approved University business, I understand that I must possess a valid California or other state driver’s license
and not have been issued more than three moving violations or have been responsible for more than three
accidents (or any combination of more than three thereof) during the twelve month period prior to travel.
Furthermore, if I am authorized to use a privately owned vehicle on travel, I will ensure that the vehicle is
covered by liability insurance in accordance with State law and carry evidence of current automobile liability
insurance in the vehicle (1. $15,000 for personal injury to, or death of one person; 2. $30,000 for injury to, or
death of, two or more persons in one accident; and 3. $5,000 for property damage); that the vehicle is adequate for
the work to be performed, is equipped with safety belts in operating condition, and is in safe mechanical condition
as required by law. If driving a personal vehicle, I understand that the mileage rate allowed is full reimbursement
for the cost of operating the vehicle, including fuel, maintenance, repairs, and both liability and comprehensive
5) For those who regularly drive on University or State business (which is defined as being equal to or greater
than once a month or equal to or greater than 12 times annually) they must complete a defensive driving training
every four years. A person who drives less than once a month or less than 12 times annually need not complete
the training.
6) Complete the STD 261 Authorization to Use Privately Owned Vehicles on State Business form if using a
privately owned vehicle for state business and retain the original in the department
( ). *University employees may also reference the
CSU's State Vehicle Use Policy manual called the CSU: Use of University and Private Vehicles Policy
Guidelines located on the CSU system wide website
Simple Travel Certification Form Free Download Previous Page
Simple Travel Certification Form Free Download