Participant Emergency Contact
Form for Trips Abroad

This form is intended to obtain insurance and emergency contact information for all those participating in University of Indianapolis international trips.

Fields marked with an asterisk * are required. If any required fields are left blank, your form will not be submitted – you will be asked to go back and complete the required fields.

General Information
* My Role in this Trip
Time abroad
Study Program
Program Contact Information Please provide contact information for the sponsoring institution and program you are attending, or trip leader

Personal Data


Insurance Details

During my participation in this UIndy Study Abroad/Short Term trip, I will be covered by the following insurance: :
Please provide the contact name and information that will provide you with required international coverage.

Emergency Contact Person Details
- Who we can contact in the US while you are abroad


Your Emergency Details
- How we can contact YOU while you are abroad

 

Please include country codes for non-US numbers