Request to Travel In-state for UMaine Extension Volunteers

The purpose of this travel form is to obtain approval for volunteer travel during the pandemic. By submitting this form and getting approval, your travel will be documented in case Extension needs to follow-up with any precautions. Thank you for your consideration of others.

Please submit your travel request at least 3-5 business days before your planned travel date.

A copy of your completed form will automatically be submitted via email to your staff contact at UMaine Extension for approval. Your staff contact is responsible for then submitting the form to the appropriate Program Administrator or Dean for their review and approval.

Volunteer's Name (person traveling)*
First Last
Volunteer's Email*
Enter Email Confirm Email
Volunteer's Phone Number*
UMaine Extension Staff Contact's Name*
First Last
UMaine Extension Staff Contact's Email*
You can find all staff email addresses at the UMaine Extension Staff Directory (link opens in a new tab/window).
Starting Point for traveler*
(physical address with number, road, town in Maine)

Street Address Address Line 2 City State ZIP Code
Destination*
Name of Business (Please indicate "Farm" or "Home" if there is no business name) Contact Person
Destination Address*
(physical address with number, road, town in Maine)

Street Address Address Line 2 City State ZIP Code
Date of planned travel*
Date Format: MM slash DD slash YYYY
Purpose of planned travel (justification in 200 words or less)*
In-state travel will only be permitted if all other options are not feasible.
Terms of Acceptance*
You must agree to all terms.
- I agree to travel solely (no other persons in the vehicle unless that person is from my household).
- I agree to use all protective measures in interacting with others — proper distancing from people — 6 feet, proper use of PPE (gloves, face mask, footwear), and disinfecting of footwear when necessary.
- I will use proper sanitation of my hands and clothing following the visit.
Electronic Signature:*
Please type your First and Last Name
*
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Phone
This field is for validation purposes and should be left unchanged.

Name of Business (Please indicate "Farm" or "Home" if there is no business name)	Contact Person