International Travel Registration

The main purpose of travel registration is to help ensure that the University has the best knowledge to assist students, staff and faculty, in the event that an emergency (medical, natural disaster, political unrest) occurs while those travelers are abroad. This form will also provide the opportunity to enroll in supplemental travel insurance.

Information you will need for this form:

- UO ID (95 number)
- Dates of travel
- Travel destinations
- Index (if you have departmental approval to charge travel insurance)

Department*
The University of Oregon department that your travel is associated with.

UO Affiliation*

Travel Purpose*
Briefly describe the purpose of your trip as it relates to official UO travel.

UO ID
(950-00-0000)

LAST NAME of traveler*
If you would like to register a group of travelers please contact Risk Management (346-2307 or riskmanagement@uoregon.edu) for instructions.

FIRST NAME of traveler*

Date of birth*
(MM/DD/YYYY)

Gender*

Local Address*
(ex. 123 Main Street)

Local City*

Local State*

Local Zip*

Contact Phone Number*
(ex. 999-999-9999)

Email Address*
Please provide the email address that you will most easily be able to access while abroad.

Global Education Oregon*
Is this trip being arranged by Global Education Oregon; please confirm your insurance will be secured through that department.

TRAVEL INSURANCE ENROLLMENT

The Office of Risk Management highly recommends supplemental international travel insurance when official UO travel involves:

- students (whether you are a student yourself or if you are traveling with students)
- when there is a particular risk in the region of travel (political unrest, recent natural disasters, etc.)
- if medical concerns exists

Coverage includes accident and sickness, security evacuations, emergency medical evacuation and travel assistance. The cost of this insurance is $2.00 per person per day. For staff/faculty with department approval, this can be charged to an index. For students, this will be charged to the student's account.

The following counties are excluded from coverage:

- Afghanistan
- Chechnya
- Iran
- Iraq
- Libya
- Pakistan

Insurance Enrollment*
Do you want to purchase travel insurance?

By indicating that you want travel insurance UO Office of Risk Management will provide your date of birth, gender and local address to the insurer for enrollment.

INDEX/Insurance Charge
For staff/faculty, what index should this expense be charged to? (In the alternative, you may provide a department contact email address if you do not know which index should be used.) By providing this information you authorize this cost to be charged to the indicated index. If you are a student and have indicated you want travel insurance, this will be charged to your student account.

Departure Date*

Return Date*

Country 1

Country 2

Country 3

Country 4

Country 5

Country 6

Country 7

Leisure Extension*
Is any portion of your trip personal travel?

Leisure Travel Start

Leisure Travel End

Comments
List additional countries if traveling to more than seven. Any additional comments:

Send me a copy of my responses

Email address