International Travel Registration

TRAVELER DETAILS

 

If you need assistance in securing a visa or determining entry and exit requirements, please contact the Intl Travel Support Office at 508-856-2840 or email internationalsupportservices@umassmed.edu

TRAVEL INFORMATION

Note: If traveler does not have known local number or globally enabled phone, please include alternate contact details (e.g., Skype, Whatsapp, Google Voice, Facebook, etc.)

If you will be conducting Clinical work, please review Insurance coverage information.  

Note: All international research must be registered with UMMS using an FPR 

EMERGENCY CONTACT INFORMATION

Do you authorize UMMS to speak to medical personnel on your behalf if your emergency contacts cannot be reached.

Certifications

Further Action Required to Enable This Review

Thank you for registering your travel with UMMS. This message is to inform you that there is a current U.S. State Department travel security warning that may be relevant to your trip.

UMMS travel to an area impacted by a U.S. State Department requires further review by the UMMS Travel Advisory Review Committee (TARC) and sign off by the UMMS Dean to qualify as UMMS sanctioned travel that is eligible for coverage under the University’s travel assistance insurance program. 

Further action on your part is required to enable this review.  Please look for a follow up email will be sent to you from International Support Services (ISS).  If your travel is imminent please contact ISS by email at InternationSupportServices@umassmed.edu.

Verify Information

Please, verify information and submit the form:

Full Name:
Department/Program:
Name of dept. head approving travel:
Email:

Status:
Country of Citizenship:

Who is your employer: #Who is your employer#

LOGISTICAL INFORMATION

Departure Date: 
Return Date:
 
Destination Country(ies):

Destination City(ies):

Phone or best way to contact you while abroad:

PURPOSE OF TRAVEL

Local point of contact (name, affiliation, email, phone): #Program Contact#

Purpose and Goals of Travel:
Other: #Other Purpose/Goal#

EMERGENCY CONTACT INFORMATION
In-country emergency contact:

Name: #Name-in-country#
Relation: #Relation-in-country#
Email: 
Phone: 

US emergency contact:

Name: #Name-US-contact#
Relation: #Relation-US-contact#
Email: 
Phone: 

Can UMMS contact the names listed above? 

 

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