Georgia State University Study Abroad Programs
Georgia State University Study Abroad Programs
Independent Travel Information Form
As part of the Study Abroad Program in ________________________________, I have chosen to travel independently, at my own expense, to the location listed below. I understand that my independent travel may involve the risk of injury or death and agree to assume all such risks. I understand that my health insurance provided by the program is no longer effective beyond the dates of the program, and that it is advisable to me to seek additional international health insurance for any pre- or post program travel. Further, I agree that the University is not responsible for me or my safety during my independent travel. I have agreed to provide the University with the following information about my independent travel.
Name: _______________________________________________________________
Location visiting: ______________________________________________________
I will be staying at the following address: ___________________________________
Phone Number: ________________________________________________________
Leaving on: ___________________________________________________________
Returning on: __________________________________________________________
Emergency Contact Information: ___________________________________________
_____________________________ ________________
Student Signature Date
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