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Main Content
International Travel Form for Faculty/Staff
International Travel Form for Faculty/Staff
INDIVIDUAL Faculty/Staff International Travel Form
"
*
" indicates required fields
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 international health insurance.
After completing this online form, submit the following forms to GPS via hardcopy to 116 Reynolda Hall
or
by email to
gps@wfu.edu:
International health insurance (GeoBlue or iNext) application
Faculty/Staff Assumption of Risk & Release
Assumption of Risk & Release – OTHER travelers, if traveling with another person (e.g. spouse or child)
Electronic Signature of Traveler
*
With the submission of this form, I confirm that I have read the International Travel Policy. I understand by signing this form that Wake Forest University reserves the right to deny funds for travel outside the United States at any time prior to departure. In the event funding is approved, I understand and acknowledge that this trip is taken on my own initiative. I further understand and acknowledge that I accept full responsibility for all risks, both known and unknown to me, which may be associated with my travel and that WFU makes no representation of any kind concerning the risks presented by my travel plans. In addition, I understand that I may be required to attend a security briefing prior to my departure.
Name of Department
*
For departmental approval, please provide the name of your department and the email address of your Supervisor or Department Chair. This form will be routed for the appropriate signature.
Name of Supervisor, Department Chair or Dean
*
Email of Supervisor, Department Chair or Dean
*
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 (select one)
*
Faculty
Staff
Other
Begin date of actual travel
*
MM slash DD slash YYYY
End date of actual travel
*
MM slash DD slash YYYY
Purpose of travel
*
(Ex. independent research, conference, scholarship recipient, professional development)
FIRST international destination (City & Country)
*
Begin date in FIRST destination
*
MM slash DD slash YYYY
End date in FIRST destination
*
MM slash DD slash YYYY
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
MM slash DD slash YYYY
End date in SECOND destination
MM slash DD slash YYYY
SECOND destination hotel/accommodation (name, address, phone number)
THIRD international destination (City & Country)
Begin date in THIRD destination
MM slash DD slash YYYY
End date in THIRD destination
MM slash DD slash YYYY
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.