Travel Waiver Request Form

 

Instructions

This form is for travelers who are planning trips to destinations with State Department Advisories of level 3 or 4, or CDC Travel Warning level 3. For faculty and staff whose travel does not fall in these advisory levels, a Concur travel request may be submitted directly and this form is not required. All students should work with the Education Abroad office regarding travel approval and international insurance.


Please complete this form in detail, addressing each point. Incomplete applications will be referred back to the traveler for additional clarification or denied based on insufficient information. Include pertinent sources or links in the fields below. You may email any supplementary documents to Emily Hassenstab at ehassenstab@unomaha.edu after submitting this request (letter of invitation or sponsorship, schedules, emails from hosting organization, etc.). Travelers who wish to undertake university sponsored international travel must complete this petition questionnaire prior to travel. The goal of this enhanced procedure is to promote decisions and practices that can mitigate heath and safety concerns, as well as the traveler’s exposure to COVID-19. This form serves as part of the approval process for UNO compliance with the NU System's Executive Memorandum 25 policy.


The traveler understands that the university may be limited in its ability to provide assistance and resources in the event of a crisis, including the possibility of being delayed in the host country due to newly imposed travel restrictions or a positive COVID-19 diagnosis.


The university retains the right to withdraw approval and/or require the traveler to leave a high-risk location at any time.

 

Traveler Information

 
 
 
 
 
 

If departure date is tentative, please enter the earliest date that you would depart.

 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
 
 
 
 
 

Travel Preparation

 
 

Ex. Online classes, modified visits or meetings, alterations in programming, ...

 
 
 
 
 
 
 
 
 

Travel Logistics

 

From which country are you departing? Will you be traveling through any other countries prior to entering your destination? What modes of transportation will you be utilizing?

 
 
 

Additionally, are there COVID-related entry requirements for your destination or points of entry prior to your primary destination?

 
 

What COVID precautions are in place? Would you be able to quarantine in this location if needed? What amenities are located on-site (wi-fi, food service, etc.)?

 
 
 
 

Health Care

 

Please describe any additional challenges with the health care system in your destination country if that is mentioned in the State Department or CDC Advisories and how you would handle emergency care.

 
 

Self-quarantine/Isolation

 
 
 
 

COVID guidelines vary based on destination and are regulated by the local government of the host country.

 
 
 
 
 
 
 
 
 

COVID Prevention

 
 
 
 

Please visit the CDC guidance for international travel. Travelers are expected to follow all CDC guidance. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html

 
 
 

I certify that the information in this application is complete and correct to the best of my knowledge. I understand that travel undertaken is of my own accord. I further understand that I am responsible for maintaining my health and safety during travel, remaining up to date and will follow guidelines and/or requirements from my host country and the US, and notifying UNO of any changes therein. UNO is not responsible for any requirements or restrictions placed on travelers by foreign entities, travel authorities, or the US. I acknowledge that given rapidly changing situations, travel approval may be revoked at any time.

 
 
 
mm/dd/yyyy
 

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.