Request for Permission to Travel

According to the terms of the exchange program agreement with Global Horizons USA, students must have signed permission from their natural parents as well as get approval from their host family and the school if they are traveling for a period longer than a weekend. Regardless of the duration of travel, if traveling by bus, train, or plane, this permission form must be signed. Permission from the school is required if they will be missing any classes.

1. REFERENCES:

a. Global Horizons-USA Student Handbook

b. Global Horizons-USA Student Agreement

While in the custody of the Host Family, Exchange Student requesting approval for

travel above shall be accompanied by an adult; minimum 25 years of age.

2. PURPOSE: The purpose of this Travel Request is to authorize travel, document the

start and stop of travel, and record the address and telephone number of where an

Exchange Students may be contacted in case of an emergency.

3. ROUTINE USE: Information furnished may be disclosed to school officials or

employees that require this information in the performance of their duties; to federal,

state, and local law enforcement authorities in appropriate cases; the American Red

Cross; and relatives. The Exchange Student shall travel with this document.

4. RESPONSIBILITY OF THE EXCHANGE STUDENT:

a. CHANGES: An Exchange Student who desires changes in authorized travel or

does not begin travel on the schedule shall notify the hgh he han

can as soon as a change is determined.

b. REPORTING: An Exchange Student on authorized travel shall report any

deviance from circumstances that authorized travel, impediments, or

emergencies through the Chain of Communication as soon as possible.

c. DEPARTURE/RETURN: An Exchange Student shall begin and end authorized

travel at the place of host residency or home country for initial travel.

d. TRAVEL EXPENSES: An Exchange Student on authorized travel shall pay for all

travel expenses, including return to the point of origin. The Exchange Student shall

have sufficient funds to pay all costs. An Exchange Student without sufficient

funds shall contact the Local Coordinator or the Director of National Operations

as soon as possible.

e. MEDICAL TREATMENT: An Exchange Student who requires medical attention

During travel, you shall visit the nearest medical facility.

If an Exchange Student becomes hospitalized by a physician, the Exchange

The student or someone acting on behalf of the Exchange Student shall contact the

Local Coordinator or the Director of National Operations directly as soon as

possible.

Information provided must include the nature of illness or injury, date and place of

hospitalization, and the name and telephone number of the attending physician.

Upon release, the Exchange Student shall obtain a written statement of

discharge/release verifying condition and including dates of treatment.

Student name*

First NameLast Name

Local Coordinator email address*

example@example.com

Email address of one of the host parents*

example@example.com

Email address of one of the parents in the home country*

example@example.com

Departure from host community*

Date

Return to host community*

Date

Destination*

Address where you will stay*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Reason of travel*

Mode of travel*

Name of the responsible adult*

First NameLast Name

Phone number of the responsible adult*

Please enter a valid phone number.

Email of the responsible adult

example@example.com

How many days will you be absent from school?*

Did the school approve your travel?*

YesNoI am not missing any school days

Did your host family approve your travel?*

YesNoI am travelling with my host family

If travelling by airplane, please upload your itinerary

Natural Parent 1*

Natural Parent 2

If you are in the USA on a F-1 visa and your trip is OUTSIDE the USA, be sure that your F-1 is a Multiple Entry Visa and the I-20 form has been signed on the last page.