Non-Student Participant Information
for Short Term International or Off-Campus Programs
Participant Information
Full Name:
*
Department or Office
Position:
*
USF Faculty
USF Staff (Non-Student)
Pre-Approved Invited Guest
Date of Birth:
*
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Month
-
Day
Year
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Primary Email Address:
*
Best Phone Number to Reach You:
*
-
Area Code
Phone Number
Will you have cell phone access while abroad?
*
Yes, I will have international coverage through my carrier or rent a cell phone on arrival
No, but I will have alternative means of being reached (e.g. hotel)
I am traveling within the U.S. and will have cell phone coverage
What USF sponsored travel are you participating in and your dates of travel?
*
*Please include city and country if traveling outside the U.S.
REQUIRED FOR INTERNATIONAL TRAVEL - provide a copy of your passport information page:
*
Yes, my passport is valid and will send a scanned copy to: stp@usfca.edu
Not valid at this time - need to renew as soon as possible
REQUIRED - provide a copy of your flight itinerary information:
*
Yes I have booked my flight and will send to: stp@usfca.edu
No, I have not yet booked my flight
I will use ground transportation
EMERGENCY CONTACT INFORMATION
Emergency Contact #1 Name:
*
Emergency Contact #1 Relation to you:
*
Emergency Contact #1 Cell Phone:
*
Emergency Contact #1 Alternate Phone Numbers (Home & Work):
*
Emergency Contact #1 Email:
Emergency Contact #2 Name:
Emergency Contact #2 Relation to you:
Emergency Contact #2 Cell Phone:
Emergency Contact #2 Alternate Phone Numbers (Home & Work):
Emergency Contact #2 Email:
Additional Information (Self-Disclosure)
Participants are advised to voluntarily disclose any medical conditions that may need to be accommodated during travel. Confidentiality will be assured and participant's disclosure will help facilitate a safe experience abroad. Please respond below:
Medical condition?
*
Yes
No
If you answered yes, please describe the condition (e.g. food allergies, medications, etc.):
*Travelers are urged to discuss the impact of extended travel with their health practitioner and strategies for managing their conditions and handling of medication. Travelers are responsible for ensuring that all medications are legally permissible abroad. Doctor's note is advisable in case questioned at customs. Prescriptions are best kept in carry-on bag rather than in checked luggage in event of delay or lost.
Attestation:
*
By checking this box, I hereby certify that all the information provided on this Participant Information Form is true and correct.
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