Student International Travel Petition

Student International

Travel Petition

Student Petition:

***The following petition form is intended for Virginia Commonwealth University students wishing to request an exception to VCU’s travel restrictions for either university-sanctioned travel or study abroad programs. Please review important information below and fully complete the form to the best of your ability. If you have any questions or concerns as you complete this form, please reach out to staff in VCU's Global Education Office by emailing ITAC@vcu.edu or abroad@vcu.edu.***

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University-Sanctioned Student International Travel:

No petition is required for Levels 1 and 2 countries.

Travel to Level 3 or 4 countries:

University-sanctioned international travel to U.S. Department of State Level 3 or Level 4 countries for students will be considered by petition to the International Travel Advisory Committee (ITAC). For travel to Level 3 and 4 countries, a final decision will be made by ITAC. Petitions to Level 4 destinations will rarely be considered.

The following form is to be used for the purpose of filing a petition and should be completed to the best of your ability. Petitions may be submitted on a rolling basis, but no later than 3 weeks prior to when travel needs to be booked. Students should expect this petition process to take, at minimum, 3 weeks.

If you are not participating in an education abroad program please indicate N/A for any sections that are not applicable to your experience abroad. Please reach out to the Global Education Office at itac@vcu.edu and abroad@vcu.edu with any questions regarding the petition process.

Name*

VCU E-mail*

V#*

What is your current status?*

Select or enter value

Other Status

Campus*

Select or enter value

Other Campus

What is your academic field of study? Please indicate all majors or minors.*

Emergency contact abroad*

Please use the box below to provide information about the person(s) and/or institution(s) that will serve as the on-site emergency point(s) of contact in your destination(s). (Ideally this should be someone that VCU can contact 24/7 to check on you if there is an emergency in the destination while you are there, and someone you would rely on in an emergency situation in your destination.)

Please use the following format:

Name of person(s) and/or organization(s)
E-mail address(es)
Phone number(s)

Contact info abroad*

Please provide a contact number where you can be reached in case of an emergency while abroad (with country code, if applicable).

Are you participating in a VCU group program/travel experience such as a VCU faculty-led study abroad program or another program led by a VCU employee?*

If you are unsure whether to select yes or no, please email Abroad@vcu.edu for guidance before answering this question.

Select or enter value

Are you the group leader for this program?*

Are you the primary, or sole group leader for a student group travel experience abroad? If you're unsure, please email itac@vcu.edu.

Select or enter value

Program/Travel Information

Study/Travel Abroad Program Name*

VCU Partner Programs*

Please select your program from the following list. If either your program provider or your host institution does not appear on this list, please select "other program."

Select or enter value

Other program

Proposed destination*

City, Country

Travel dates*

Host institution name*

Please provide the name of the host institution where you will be enrolled.

If you will not be affiliated with a host institution in-country, please provide details on other on-site support that you will receive, including emergency contact names and details (such as phone, email, address).

Travel advisory level*

Please indicate the U.S. Department of State (DOS) travel advisory level for the country to which you wish to travel and provide the date on which you checked the DOS website. To determine, please visit: https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html/

CDC level*

Please indicate the CDC risk assessment level of the country to which you wish to travel, as well as any restrictions for inbound travel and provide the date you checked the CDC website to determine the level. To determine, please visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html

Program contact*

Please provide the name, phone number, address, email, and website for the program's contact person in the U.S. This should be an individual that can be contacted 24/7 for emergency assistance.

On-site contact*

Please provide the name, phone number, address, email, and website for your on-site contact person. This should be an individual that can be contacted 24/7 for emergency assistance.

Support services*

Please describe support services provided by the program/host institution. Support services include orientation, availability of on-site staff, intercultural programming, assistance with course enrollment, medical facilities, and others.

Please also use this space to provide information about your proposed activities in the destination.

Travel arrangements*

Please describe your intended travel arrangements to and from your host institution, including any stopovers and any quarantine, testing, or vaccination requirements that may exist and the mode of transportation (e.g. private vehicle, public train, or taxi).

Visa requirements*

Please describe the visa or other entrance requirements (such as proof of vaccination) for the host country and any assistance provided by the program/host institution to meet those requirements.

Emergency procedures*

Please describe the emergency procedures of the program/host institution. (e.g. in the event of a natural disaster, political unrest, widespread medical emergency)

Refund/withdrawal policy*

Please provide specific information about the refund/withdrawal policy of your program provider or institution.

Personal risk mitigation*

Please describe in detail specific resources you have reviewed/consulted to identify potential risks present in the host destination and describe how you plan to mitigate those risks.

Please comment on ALL types of risks including, but not limited to, health, safety, and security.

Specifically, you are expected to address how you will mitigate the specific risks mentioned in the U.S. Department of State's current travel advisory; otherwise, your petition will be returned to you.

Please also use this space to provide details on any previous travel experiences you have to this destination, or in other high-risk destinations.

Group Program Info

Group Program Name*

VCU Employee Group Program Leader Name*

If program is not being led by an employee, please make a note of that and provide their role at VCU (title and unit).

Group Program Leader's e-mail*

International travel insurance acknowledgement

Cultural Insurance Services International (CISI) is travel emergency services provider for VCU Richmond-based student travelers while on university-sanctioned international travel. Coverage is not automatic and requires enrollment, so students must work with GEO to ensure enrollment.

Please read and acknowledge the following regarding the CISI plan for students:

I acknowledge that upon approval of my petition, I will contact GEO to register my travel and enroll in international health and emergency assistance insurance.*

I acknowledge that I am a VCUarts Qatar-based traveler and automatically enrolled in Global Rescue, which does not provide medical insurance. If I have questions about medical health insurance coverage abroad, I will consult VCUarts Qatar Student Affairs.*

Statement of Affirmation*

By checking this box, I affirm that all information provided in this petition for an exception to the VCU travel restriction is accurate. Furthermore, I hereby give permission for the information I provided in this petition to be shared with members of the VCU International Travel Advisory Committee (ITAC) and other individuals at the university or outside the university (as needed) for the purpose of verifying on-site support, and reviewing my capability to mitigate risk in the destination in order to offer a recommendation for my petition request. I will follow all U.S. Department of State and CDC guidelines for international travel.

Send me a copy of my responses

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