UNITED STATES PROBATION OFFICE Central District of California TRAVEL REQUEST FORM Date: U.S. Probation Officer: GENERAL INFORMATION: Supervisee's Name: Home Phone Number: Address: City/State/Zip: Email Address: DESTINATION INFORMATION: City/State: Departure Date Return Date: Purpose of trip: PROPOSED ACCOMMODATIONS: Name/Hotel: Address: City/State/Zip: Phone: PROPOSED TRANSPORTATION: VEHICLE: Make/Model/Color: License Plate Number: Registered Owner: AIRLINE: Name of Airline: Airport, Departure Time, & Flight Number: Airport, Return Time, & Flight Number OTHER MODE OF TRANSPORTATION (Specify): Relationship: Cell Phone Number: Persons traveling with/ Relationship: Signature of Supervisee SUP 255 Rev. 1/5/10 American LegalNet, Inc. www.FormsWorkFlow.com