UVM Travel Information Form

For UVM Faculty, Staff and Students. Please complete this form before you travel out of the U.S. This information will be kept strictly confidential and will only be used to locate you in the event of an international emergency.

First Name
Middle Name
Last (family) name

UVM ID Number

Affiliation within UVM:

Faculty
Staff
Student
Other (specify)

Department

Please enter an emergency contact in the U.S.

First Name
Middle name
Last (family) name

What is the purpose of this trip? Please enter your passport information (optional)

Passport No.

Expiration Date

Country of Issue

Please List Important Visas for Travelling

Country
Visa No.
Country
Visa No.
Country
Visa no.

Please add any additional information we should know about this trip