International Away Elective Clerkship Travel Checklist

International Away Elective Clerkship Travel Checklist

Instructions

The International Away Elective Clerkship Approval Request Form must be submitted and approved prior to submitting this checklist. Complete the checklist prior to participating in the international clerkship. The checklist items below must be completed to receive final approval for participating in the international elective clerkship.

Last Name:*

First Name:*

Stanford ID #:*

Stanford Email Address:*

International Institution/Program Name:*

Institution/Program Country:*

Current Travel Risk Rating:

Look up country's travel risk

If applicable, Stanford clerkship (department code & number, e.g. PEDS 306I):):

Clerkship Schedule (Fishbowl) change request for international clerkship sent to medregistrar@stanford.edu*

When enrollment for the applicable quarter is open, will enroll in Axess*

Obtained Travel Itinerary (upload below):*

Reviewed Stanford's International Travel Assistance Program information (https://internationaltravel.stanford.edu/)*

Submitted Emergency Record information (upload below)*

Providing copy of Passport (upload below):*

Providing copy of Visa, if applicable (upload below):

Consulted with Vaden's Travel Clinic and completed required immunizations (see https://vaden.stanford.edu/make-appointment/travel-health)*

For High or Extreme risk travel: Registered in STEP (U.S. State Dept. Smart Traveler Enrollment Program) (upload below)

For High or Extreme risk travel: Completed Stanford Travel Release (upload below)

Name of Clerkship Preceptor/Administrator:*

Preceptor/Administrator's Job Title:*

Preceptor/Administrator's Address*

Preceptor/Administrator's Email Address:*

Preceptor/Administrator's Phone Number (include international code):*

Your expected address while participating in the clerkship:*

Your expected phone number:*

Your expected email address (if not Stanford email):

Residence contact name:

Residence contact phone number:

Residence contact email address:

If you have pre- or post- international clerkship travel plans, please provide details including dates:

Closest US Embassy or Consulate Address:*

https://www.usembassy.gov

Closest US Embassy or Consulate phone number:*

US-based emergency contact name:*

US-based emergency contact address:*

US-based emergency contact phone number:*

US-based emergency contact email address:*

Upload required documents:*

Travel Itinerary
Emergency Record completion (can be a screenshot)
MyTrips completion (can be a screenshot)
Copy of passport
If applicable:

Visa
Dept of State Smart Traveler/STEP registration
Stanford Travel Release & Waiver

Drag and drop files here or

Use the box below to enter any comments or questions regarding your planned international travel:

Upon completion of the away clerkship, I will check that my evaluation is submitted. I will meet with my Advising Dean to discuss my experiences and review how it has impacted academic and/or career plans.*

Send me a copy of my responses

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