International Experience Form

This form is to be completed by the FIU faculty member, administrator, employee who is coordinating this experience. Please provide the information requested below. This will be used to gather important details about your trip, and also to register you in the mandatory Travel and Health Insurance.

Thank you

TRIP COORDINATOR/LEADER INFORMATION
Trip Coordinator's Name Trip Coordinator's Name First Last
Email
Phone Number Phone Number - ### - ### ####
FIU Panther ID
Program/Department
College
Please upload a copy of the biographical page of your passport (for Travel Insurance Registration purpose)

Attach Files
Name of Additional Coordinator (if any) Name of Additional Coordinator (if any) First Last
Email of Additional Coordinator
Please upload a copy of the biographical page of additional coordinator's passport (for Travel Insurance Registration purpose)

Attach Files
INFORMATION ON YOUR TRIP
NAME OF TRIP (For example- "Service Learning in Peru")
TRIP DESTINATION (Country)
CITIES THAT WILL BE VISITED
Trip Start Date Trip Start Date / MM / DD YYYY
Trip End Date Trip End Date / MM / DD YYYY
Please upload a file with the TRIP ITINERARY

Attach Files
Please provide a description of the purpose of this trip
Please provide a description of the safety measures during your trip. (How is the group going to circulate upon arrival and while in the country- taxis, public/private transportation, etc.)
If your department/college/program wil be paying for the participants' Travel Insurance , please provide the DEPARTMENT INFORMATION
If your department/college/program wil be paying for the participants' Travel Insurance , please provide the ACTIVITY NUMBER to be charged.
INFORMATION ON TRIP PARTICIPANTS

Please upload an Excel file with a list containing the names, e-mails, and positions of the trip participants.
List of Participants- Thank you for uploading this information!

Attach Files
EMERGENCY PROCEDURES

The Office of Study Abroad wants to make sure you have all the information you need while abroad. Please access our EMERGENCY PROCEDURES MANUAL found on this link (Please copy and paste to your browser to access document)
https://globalaffairs.fiu.edu/wp-content/uploads/sites/40/2019/12/International-Travel-Emergency-Action-Plan-Dec-6-2019.pdf
I acknowledge that I have read and understood the information provided in the Emergency Procedures Manual and I agree to be bound by the policies, rules, and regulations set forth in this document.
Your Signature. (Enter your full name below) Thank you!
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International Experience Form

International Experience Form

TRIP COORDINATOR/LEADER INFORMATION

INFORMATION ON YOUR TRIP

INFORMATION ON TRIP PARTICIPANTS

EMERGENCY PROCEDURES