Student Travel Abroad Registration Form

Personal Information

Name

University ID#

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…

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)

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)

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 attached the required waiver.

I am not traveling to a country under a travel advisory Level 3.

Please attach a copy of the information page of your passport

One file only.
50 MB limit.
Allowed types: gif, jpg, jpeg, png.

Conditions of Participation

Please download, print, and sign the Conditions of Participation for Students Traveling Internationally Under the Auspices of the University of Iowa. Upload the signed document below.
One file only.
50 MB limit.
Allowed types: pdf, doc, docx.

Please upload the signed travel waiver form.

One file only.
50 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, avi, mov, mp3, ogg, wav, bz2, gz, sit, svg, tar, zip.

By checking the box below, I certify that:

to the best of my knowledge, the information in this application is correct
I 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.