Foip Notification The personal information requested on this form is collected under the authority of Section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act of Alberta. It will be used for the purpose of administering the University of Lethbridge’s Student Safety Abroad program. Questions about this collection can be directed to the University’s FOIP Coordinator at 4401 University Drive, Lethbridge, AB T1K 3M4; foip@uleth.ca; 403-332-4620. Personal Travel Form Please use this form to record details of University sponsored and sanctioned travel. Registration of personal travel is not required. Personal Information University ID Number: * First Name: * Last Name: * Email: * Campus: * - Select -LethbridgeCalgary Are you a: * Please SelectStudentVolunteer/CommunityStaff/Faculty Degree Level: * - Select -BachelorsPhDMasters Home Contact Information Telephone Number: * Format: (XXX)-XXX-XXXX Local Address: * City: * Province/State: * Country: * - Select -AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African Republic (CAR)ChadChileChinaColombiaComorosDemocratic Republic of the CongoCongo Republic of the CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (formerly Swaziland)EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth Macedonia (formerly Macedonia)NorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab Emirates (UAE)United Kingdom (UK)United States of America (USA)UruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe Postal Code/Zip Code: * Primary Emergency Contact Contact Name: * What is your primary contact's relationship to you?: * Telephone Number: * Format: (XXX)-XXX-XXXX Passport Information Is your Passport valid 6 months beyond Date of Return? * Yes No Every country or territory decides who can enter or exit through its borders. The University of Lethbridge cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements. Entry requirements vary depending on the type of passport you use for travel. Before you travel, understand what requirements your passport must meet including ensuring it remains valid for the duration of your travel and any additional time requirement beyond completion of travel. Generally a minimum 3-6 months beyond the date you complete your travel. Please refer to specific country requirements prior to departure. Different entry rules may also apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest diplomatic mission for your destination or International SOS as appropriate. Passport Issuing Country: * - Select -AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African Republic (CAR)ChadChileChinaColombiaComorosDemocratic Republic of the CongoCongo Republic of the CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (formerly Swaziland)EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth Macedonia (formerly Macedonia)NorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab Emirates (UAE)United Kingdom (UK)United States of America (USA)UruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe Citizenship Country: * - Select -AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African Republic (CAR)ChadChileChinaColombiaComorosDemocratic Republic of the CongoCongo Republic of the CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (formerly Swaziland)EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth Macedonia (formerly Macedonia)NorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab Emirates (UAE)United Kingdom (UK)United States of America (USA)UruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe Do you hold a multiple citizenship? * Yes No Other Citizenship Country: Do you require a visa for your trip? * Yes No Travel Documents What type of Visa do you have? * Student Business Other Other Visa: Is the Visa valid for duration of travel? * Yes No Please explain why not? Country Details * Do not include any personal travel or layovers. Destination Country: * - Select -AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African Republic (CAR)ChadChileChinaColombiaComorosDemocratic Republic of the CongoCongo Republic of the CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (formerly Swaziland)EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth Macedonia (formerly Macedonia)NorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab Emirates (UAE)United Kingdom (UK)United States of America (USA)UruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe City: * Are you travelling to other destinations on this trip? * Yes No Please include information for the other countries of travel: Enter your estimated dates of travel for this destination. Start Date: * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20212022202320242025 Year End Date: * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20212022202320242025 Year Travel Details and Itinerary Indicate your primary purpose of travel: * Please SelectInternship/PracticumBusinessConferenceWork StudyAthletic ProgramsExchangeResearchOther Please specify other purpose of travel: * Insurance It is the responsibility of the traveller to ensure sufficient health, travel and property insurance is in order prior to departure to respond to travel exposures. It is a required component for University sanctioned travel for each traveller to have a travel health insurance program in place to respond to medical emergencies and repatriation should it be required. To learn more about traveling insurance, contact Campus Safety. Health Insurance Provider: * Health Insurance Policy Number: * Agreement I declare that I am aware of the risks and hazards associated with my travel and in the event of an emergency I understand that it may be shared with International SOS. For current advisories and country risk analysis please log in to International SOS web portal using the UofL’s unique membership number, visit the Canadian government site at travel.gc.ca and/or contact Campus Safety at email: insurance.risk@uleth.ca , Telephone: 403-329-2603 for further assistance. You may not submit this form until you are orientated for specific country risks and related University policy and processes. In the interest of my safety abroad, I agree to ensure that the information in the Safety Abroad Registry remains accurate and I will report any changes as appropriate and necessary to Campus Safety. I understand that regardless of a Country’s current advisory rating and status, I know this can change without notice and I accept that it is my responsibility to ensure I remain informed about risks and take appropriate precautions to avoid and mitigate where possible. I also confirm that I have sufficient travel insurance coverage for the duration of my trip that can respond to incidents and personal exposures. Leave this field blank Submit