Breadcrumb Home Student Travel Abroad Registration Form You must have JavaScript enabled to use this form. Personal Information Name University ID# Email NOTE: Your UI email address will be used for all necessary communication while you are abroad. Emergency Contact Name Cell Phone Work Phone Email Address Relationship to you Travel Information Purpose of travel (check all that apply) Credit-earning academic program Internship/practicum Service learning/community engagement Volunteering Conference Other… Enter other… Name of faculty/staff If travel is funded, promoted, or organized by a University of Iowa college/unit or faculty/staff member, provide contact: College/Unit Primary Destination (city, country) Start date of UI-related travel End date of UI-related travel Additional countries you will visit (include dates) NOTE: Personal travel and/or vacation time is not to be included on this form. See Purchase of Coverage for Personal Travel if you wish to purchase additional coverage Will you earn academic credit for your time/work abroad? No, I will not earn credit for my activities abroad. Yes, a UI department/college will grant credit for the work I do outside the U.S. Yes, an accredited institution other than UI will grant credit for the work I do abroad, and I would like to transfer this credit to UI. Other (please explain) Enter other… Name of UI department granting credit UI department contact name and email Name of institution granting credit Location Contact name/email address NOTE: If your plans include travel to an area that is currently under a U.S. State Department travel advisory Level 3 (reconsider travel), you may need to complete an additional waiver form. Email safety-abroad@uiowa.edu about this requirement. Student travel under the auspices of UI is not approved for locations where the U.S. State Department assigns a Level 4 (do not travel) rating. I am traveling to a country under a travel advisory Level 3 and have signed and emailed the required waiver to safety-abroad@uiowa.edu. I am not traveling to a country under a travel advisory Level 3. By checking the box below, I certify that:to the best of my knowledge, the information in this application is correctI understand that I will be enrolled in the mandatory CISI insurance program and the charges will appear on my U-Bill. I agree to the terms above. Leave this field blank