International Travel Form GROUP NOT For Credit

HAVE ALL YOUR INFORMATION TOGETHER BEFORE BEGINNING THIS FORM.
Review the International Travel Policy.
All fields on this form are MANDATORY for the purposes of registering your travel with the WFU/Worldcue Traveler 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 the international health insurance.
IF THERE IS MORE THAN ONE GROUP LEADER, EACH LEADER SHOULD COMPLETE THIS FORM.

Electronic Signature of Group Leader*

By signing below, I confirm that I have read the International Travel Policy. 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.

Name of Department*

Please provide the name of your department and the email address of your Department Chair, Unit Head or Dean. This form will be routed for the appropriate signature.

Name of Supervisor, Department Chair or Dean*

Email of Supervisor, Department Chair or Dean*

Group leader(s) must turn into GPS*

(Check your acknowledgment of each item)

List of group participants

International health insurance (GeoBlue) enrollment form

Faculty/Staff Assumption of Risk & Release form

Faculty/Staff Director Guidelines form (completed and signed by Faculty/Staff Director)

Notifications of any changes in participants

Copy of program itinerary with contact information

Group leader must verify that EACH PARTICIPANT has completed the items listed below.*

(Check your acknowledgement of each item)

Health Questionnaire

Student/Faculty Staff Assumption of Risk & Release forms

Application for GeoBlue International Health Insurance

These forms are located at International Travel Forms GROUP NOT For Credit

Name of Traveler*

First Middle Last

WFU ID (8 numbers, include leading 0 if applicable)*

Email*

Cell or Home phone*

Unit (select one)*

College

Business School

Graduate School

Law School

Divinity

Other

Affiliation*

Faculty

Staff

Other

Begin date of actual travel*

End date of actual travel*

Purpose of travel*

(Ex. independent research, conference, scholarship recipient, professional development)

FIRST international destination (City & Country)*

Begin date in FIRST destination*

End date in FIRST destination*

FIRST destination hotel/accommodation (name, address, phone number)*

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.

SECOND international destination (City & Country)

Begin date in SECOND destination

End date in SECOND destination

SECOND destination hotel/accommodation (name, address, phone number)

THIRD international destination (City & Country)

Begin date in THIRD destination

End date in THIRD destination

THIRD destination hotel/accommodation (name, address, phone number)

If traveling to MORE than THREE destinations, upload a file with your complete itinerary

Accepted file types: jpg, gif, png, pdf, docx, Max. file size: 32 MB.

Domestic Emergency Contact Information

Name*

First Last

Relationship to you*

Cell or Home phone*

Address*

Street Address Address Line 2 City State ZIP Code

Email of emergency contact

Additional overseas contact if available (name, address, phone)

Name

This field is for validation purposes and should be left unchanged.

Global Wake Forest

International Travel Form GROUP NOT For Credit

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