Safety Abroad Registry

Foip Notification

The personal information requested on this form is collected under the authority of Section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act of Alberta. It will be used for the purpose of administering the University of Lethbridge’s Student Safety Abroad program. Questions about this collection can be directed to the University’s FOIP Coordinator at 4401 University Drive, Lethbridge, AB T1K 3M4; foip@uleth.ca; 403-332-4620.

Personal Travel Form

Please use this form to record details of University sponsored and sanctioned travel. Registration of personal travel is not required.

Personal Information

University ID Number: *

First Name: *

Last Name: *

Email: *

Campus: *

Are you a: *

Degree Level: *

Home Contact Information

Telephone Number: *

Format: (XXX)-XXX-XXXX

Local Address: *

City: *

Province/State: *

Country: *

Postal Code/Zip Code: *

Primary Emergency Contact

Contact Name: *

What is your primary contact's relationship to you?: *

Telephone Number: *

Format: (XXX)-XXX-XXXX

Passport Information

Is your Passport valid 6 months beyond Date of Return? *

Yes

Every country or territory decides who can enter or exit through its borders. The University of Lethbridge cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

Entry requirements vary depending on the type of passport you use for travel. Before you travel, understand what requirements your passport must meet including ensuring it remains valid for the duration of your travel and any additional time requirement beyond completion of travel. Generally a minimum 3-6 months beyond the date you complete your travel. Please refer to specific country requirements prior to departure.

Different entry rules may also apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest diplomatic mission for your destination or International SOS as appropriate.

Passport Issuing Country: *

Citizenship Country: *

Do you hold a multiple citizenship? *

Yes

Other Citizenship Country:

Do you require a visa for your trip? *

Yes

Travel Documents

What type of Visa do you have? *

Student

Business

Other

Other Visa:

Is the Visa valid for duration of travel? *

Yes

Please explain why not?

Country Details

* Do not include any personal travel or layovers.

Destination Country: *

City: *

Are you travelling to other destinations on this trip? *

Yes

Please include information for the other countries of travel:

Enter your estimated dates of travel for this destination.

Start Date: *

Month

Day

Year

End Date: *

Month

Day

Year

Travel Details and Itinerary

Indicate your primary purpose of travel: *

Please specify other purpose of travel: *

Insurance

It is the responsibility of the traveller to ensure sufficient health, travel and property insurance is in order prior to departure to respond to travel exposures. It is a required component for University sanctioned travel for each traveller to have a travel health insurance program in place to respond to medical emergencies and repatriation should it be required. To learn more about traveling insurance, contact Campus Safety.

Health Insurance Provider: *

Health Insurance Policy Number: *

Agreement

I declare that I am aware of the risks and hazards associated with my travel and in the event of an emergency I understand that it may be shared with International SOS.

For current advisories and country risk analysis please log in to International SOS web portal using the UofL’s unique membership number, visit the Canadian government site at travel.gc.ca and/or contact Campus Safety at email: insurance.risk@uleth.ca , Telephone: 403-329-2603 for further assistance. You may not submit this form until you are orientated for specific country risks and related University policy and processes.

In the interest of my safety abroad, I agree to ensure that the information in the Safety Abroad Registry remains accurate and I will report any changes as appropriate and necessary to Campus Safety. I understand that regardless of a Country’s current advisory rating and status, I know this can change without notice and I accept that it is my responsibility to ensure I remain informed about risks and take appropriate precautions to avoid and mitigate where possible. I also confirm that I have sufficient travel insurance coverage for the duration of my trip that can respond to incidents and personal exposures.

Leave this field blank

Please use this form to record details of University sponsored and sanctioned travel. Registration of personal travel is not required.

Campus Safety

Security Services

Students

Information for

Campus