Please Provide Traveler's Information:
Please provide your current local address
Please indicate your purpose of travel.
Select all that apply:
Itinerary: Please enter below the arrival and departure dates for each destination in your itinerary. For multiple destinations, enter each destination location and dates.
In which college are you enrolled?
If yes, please provide the Name, ID number, and email address of the student/resident or faculty; you may enter them in the box provided above.
UAMS does NOT support student travel, research or study in countries currently under a Travel Warning. Please refer to Academic Policy 1835.00 "Adhering to Overseas Travel Warning Policy" (provost.uark.edu/183500.pdf)
Emergency Contact Information
Please indicate your plans for accessing emergency medical care:
For example, contacting the in-country emergency contact, proceeding to the nearest hospital (hospital name/address), etc.
For example, contacting the in-contry emergency contact, contacting the nearest US Embassy or Consulate, calling the number on the AIG travel insurance card, etc.
This field is for validation purposes and should be left unchanged.