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 UMass Boston

International Pre-Travel Export Control and Risk Form

Once completed, this form must be attached to the related Pre-Travel Authorization Request in Concur

(Use same name and spelling as the “Request Name” field in your Concur Travel Request)
Traveler

(Please use same name and spelling as that in your Concur Travel Request)

(University of Massachusetts email address only)

Enter an email address here if you would like to CC this form to someone else when it's completed
(University of Massachusetts email address only)

(If you are both an employee and a student, please check both applicable boxes)

  • Note: All International Group Travel involving students requires the Conditions of Agreement Form. This international travel liability release form must be filled out and signed by each UMass Boston student (including minors) and volunteer traveling as part of a group internationally. Completed forms must be uploaded to the Travel Request.



(Risk Lookup)
Insurance and Emergency Services

(Review UMass International Travel Insurance Brochure)

(Download UMass travel accident and sickness insurance Travel Card)
Traveler Contact Information While Traveling



(Include country code + city code)


(e.g. email, WhatsApp, We Chat, Instagram, Facebook name, Twitter name, etc.)

Emergency Contact Information
In-Country/On-site Emergency Contact:
(This can be a member of a partner organization/s, a personal contact, or anyone who will be on-site with you and who can be contacted in the event of an on-site emergency)
(Provide contact information for your in-country partner, collaborator, host organization and/or placement agency.  Please list additional partners below if there are more than one contact.)


(Include country code + city code)

Personal Emergency Contact:



Primary Campus Contact: (Campus Contact should be someone who will be in the United States during your Travel)




(Please note: communication should include a minimum of a check-in when you arrive on-site, at least one check-in communication during the program, and preferably weekly check-ins.)
Export Control/IT Review (required)





High Risk Questionnaire for Faculty/Staff

Personal Safety Plan for High Risk Travel






(e.g., on-site orientations, familiarization tour of area, accompaniment of staff, after hours emergency number, local clinic, evacuation services, emergency protocols, etc.)



(U.S. Embassy lookup)

(Lookup 911 Emergency Equivalent Number)

(Please note: the UMass Boston Travel Clinic can provide vaccinations, recommendations, and individual country reports for University Travelers. However, it is your responsibility to check with a medical professional regarding concerns you may have regarding your personal health, medical conditions and mental health, medications you take, and risks related to asthma or any allergies you may have.)
High Risk Questionnaire for Students






(e.g., on-site orientations, familiarization tour of area, accompaniment of staff, after hours emergency number, local clinic, evacuation services, emergency protocols, etc.)

(Lookup U.S. Embassy or consulate)

(Lookup 911 Emergency Equivalent Number)

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