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International Travel Form for a Group of Faculty/Staff

GROUP International Travel Form for FACULTY/STAFF

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
  • All fields on this form are MANDATORY for the purposes of registering your travel with the WFU/Crisis24 Horizon system.
  • This form should be completed as soon as possible prior to traveling so that we have sufficient time to register your travel and purchase international health insurance.
  • IF THERE IS MORE THAN ONE GROUP LEADER, EACH LEADER SHOULD COMPLETE THIS FORM.
Group leader(s) must turn into GPS:
(Check your acknowledgement of each item)
NOTE: BCBS Global (formerly GeoBlue) or iNext international travel insurance is required fr each group leader and faculty/staff participant for teh duration of this program. The cost of this insurance will be billed to the program.
Group Leader must verify that EACH PARTICIPANT has the completed the following items:
(Check your acknowledgement of each item)
Primary Group Leader should collect all forms and turn them in to GPS.
By signing below, I understand that for reasons of security/safety, WFU may deny funds for travel outside the United States at any point prior to departure. However, I understand and acknowledge that the provision of funds for international travel does not imply that Wake Forest University accepts responsibility for any risks associated with the travel. In addition, I understand that I may be required to attend a security briefing prior to departure. I understand that I must submit all required forms to GPS and perform all required tasks before departure.

Depending on whether you are FACULTY or STAFF, please provide the information below. This form will be routed for the appropriate signature.

Name of Group Leader*
Unit (select one)*
Affiliation*
MM slash DD slash YYYY
MM slash DD slash YYYY
(Ex. independent research, conference, scholarship recipient, professional development)
Questions for Travel Authorization
Will you be conducting Fieldwork as part of this trip? Fieldwork is defined as activities authorized by the University (study, research, teaching) undertaken by faculty, staff, and students, at a location away from the main campus, buildings, or leased offices and take place outside.*
Will you be traveling with university owned computer(s) or external device(s), remotely accessing WFU information systems and servers, or traveling with tangible materials or other university owned equipment?*
Will you be traveling with or accessing any WFU proprietary information or materials not intended for public access?*
Will you be traveling with or accessing any sensitive, regulated, export-controlled, controlled unclassified, or intellectual property information, data, equipment, or technology during the course of your travel?*
Note: This question includes information, data, equipment, and technology that is controlled by any federal, state, university, or contractual law, regulation, or obligation. Examples Include: Export Administration Regulations (EAR), International Traffic in Arms Regulation (ITAR), Controlled Unclassified Information (CUI), Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA)
Is this travel part of your contractual obligations for sponsored research where the sponsor or prime contractor is a U.S. Government agency, corporation or private foundation?*
Itinerary
MM slash DD slash YYYY
MM slash DD slash YYYY
If you do not have your accommodation information at this time, “TBD” is acceptable here. Once your plans are finalized, submit AS SOON AS POSSIBLE to GPS.
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Accepted file types: jpg, gif, png, pdf, docx, Max. file size: 32 MB.
Domestic Emergency Contact Information
Name*
Address*

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