Submission Deadlines

International Group Travel Health & Safety Approval Form

All University of Michigan-Flint faculty and/or staff who propose to take students abroad are required by the Office of the Provost and Vice Chancellor for Academic Affairs to gain health and safety approval for their program through the International Travel Advisory Committee (ITAC). The primary purpose of this requirement is to address the significant health, safety, and liability issues that exist when students go abroad as part of a university led/sponsored experience. Individual departments, including the International and Global Studies Program (IGS), and those within the College of Arts and Sciences, School of Education and Human Services, School of Health Professions and Studies, and the School of Management retain academic and pedagogical autonomy in study abroad trips.

Faculty/staff leader(s) should be aware of the U-M Travel Policy and country-specific health and safety information as they develop their program. This information can be found at:

Submission Deadlines

For Health and Safety Review Only / For Health & Safety Review,
International and Global Studies (IGS) Scholarships, and Education Abroad Office Marketing
This form must be submitted a minimum of 90 days prior to trip commencement. / This form must be submitted by May 15 of the previous year. This deadline ensures that approved trips will be included in fall term marketing campaigns.

Review Period

International group travel programs are generally reviewed on a rolling basis, up to 90 days prior to a trip’s commencement. Decisions are generally communicated to faculty within a 1 – 2 week period.

To view an example of a completed and concise form, visit:

For questions please contact ITAC Chair, Maureen Tippen at ph: 810-762-3420

or Asinda Sirignano, Education Abroad Coordinator, ph: 810-762-0867.

In Case of an Emergency While Traveling Outside of the United States
Medical Emergency Seek immediate care with nearest physician or nearest hospital
Schedule Doctor VisitContact HTH Insurance +1-610-254-8771 (24/7, call collect)
Personal Safety / CrimeContact Embassy Emergency After-Hours Phone (see page 3)
Contact Local Emergency Number (911 equivalent / Police) (see page 3)
Notify U-M Department of Public Safety (DPS)*+1-810-762-3333 Flint
*DPS can notify the International Travel Advisory Committee (ITAC) and your Dean/Director who can provide additional assistance.

Instructions

Complete this form thoroughly and attach a tentative itinerary of the program.

Failure to provide adequate information will lead to a delay in approval for health and safety.

FACULTY/STAFF INFORMATION (required)
Title (Dr, Ms, Mr, etc): / Applicant Name:
This person is the ‘Group Leader’ / Title(Dr, Ms, Mr, etc): / Name of Co-Applicant (if applicable):
This person is the ‘Co-Group Leader’
Academic Rank (if applicable): / Co-Applicant Academic Rank (if applicable):
Uniqname: / Co-Applicant Uniqname:
Campus Address:
Campus Phone: / Campus Address:
Campus Phone:
Department/Schl/College: / Department/Schl/College:
Business Administrator (Person within primary applicant’s department who will be handling the budget account and financial paperwork)
Name:
Campus Phone: Uniqname: / Primary UM-Flint department contact:
Uniqname:
Contact abroad if you are unavailable:
Email:
Phone:
TRIP& EMERGENCY CONTACT INFORMATION (required)
Title:
In50 -150 words, please provide a programoverview:
Destination (Countries & Cities):
Anticipated Departure Date: / Anticipated Return Date:
Anticipated Number of Student Participants:
Accommodations Abroad (may include but is not limited to hotels, hostels, residence halls, homestays, etc.):
Name: Dates:
Address: Phone (include country code):
Name: Dates:
Address: Phone (include country code):
Name: Dates:
Address: Phone (include country code):
Name: Dates:
Address: Phone (include country code):
Please complete ALL communication methods that you plan to have access to while traveling:
Your US cell phone number(s): Have you confirmed this will work at your destination? No Yes
Do you plan to purchase a local cell phone? No Yes (If yes, please send the number to once available)
Satellite Phone Number: Alternate Email(s):
Do you anticipate not having regular access to phone or Email communication? No Yes
If yes, what is the best way to reach you?:
Do you plan to maintain regular communication with a UM-Flint Faculty or Staff member? No Yes
If yes, with whom and how often?:
Please provide the name(s) of onsite hosts/colleagues and their contact information:
Name: Email:
Address: Phone (include country code):
Name: Email:
Address: Phone (include country code):
Address of Nearest U.S. Embassy or Consulate (visit to determine): / Embassy Main Phone (include country + city code):
Emergency After Hours Phone (include country + city code):
Do you have Embassy or Consulate contact information for any non-U.S. citizen travelers? No Yes
If not, would you like assistance to obtain this information?
No Yes / Name and Address of Nearest Hospital (visit to determine):
Phone (include country + city code):
City/Country 911 Emergency Equivalent Number (visit to determine:
COUNTRY SPECIFIC HEALTH & SAFETY INFORMATION (required)

1. What are the specific health and safety risks at your destination(s)? Refer to U.S. State Department Country Profiles at and the Center for Disease Control (CDC)

1. What strategies will you and the group take to mitigate these specific health and safety risks?

1. What strategies will travelers take to mitigate other health and safety risks such as limited language, culture, possession and use of expensive equipment, etc.?

1. Describe the transportation methods that will be used during the program.

1. Are there required vaccinations for travel to this destination(s)? Visit to determine.  No  Yes

If yes, what is the anticipated date to ensure travelers have received recommended vaccinations?

1. Local language(s) at your destination:

How would you rate the Group Leader(s)’ VERBAL communication skills in the local language(s)?
 None  Beginner  Intermediate  Advanced  Fluent
If verbal skills are limited, what communication strategies will the Group Leader(s) employ?
7. Please describe the Group Leader(s)’ experience (i.e. previous travel to this destination, previous travel leading students, etc.):
UNIVERSITY TRAVEL WARNING (required only for programs under a University Travel Warning)
The U-M International Travel SPG #601.31 prohibits undergraduate students from traveling on university-related purposes to destinations under a University Travel Restriction. For countries where a University Travel Warningis in place, ITAC requires gourp leaders to provide additional information. View University Travel Warnings at .
Is there is a University Travel Warningfor your country or region? No (please skip to page 5) Yes (please answer #1 - 5 below):

1. Explain the academic/service relevance of the program for the students in light of the University Travel Warning.

1. Please provide list of all cities and towns visited and anticipated time per location, including in-transit cities.

1. Provide a brief overview of the accommodations (hotel, hostel, host families, camping, etc.)

1. Describe any onsite health, safety and security support resources and services.

1. Please describe plans for country specific pre-departure orientation, on-site arrival orientation, and post-trip debrief or evaluation, including addressing health and safety and security risks and mitigation strategies.

FACUTLY/STAFF LEADER (S) SIGNATURE
I am aware that faculty or staff who lead education abroad trips are expected to follow the health, safety, and liability guidelines as put forth by the University. I am also aware that I must adhere to University-system fiscal responsibilities as stated in the Standard Practice Guide.
Signature of Primary Applicant: ______Date: ______
Signature of Co-Applicant (if applicable): ______Date: ______
ENDORSEMENT
Given the needs within our department/school/college, I endorse this trip. It is understood that budget overruns are to be paid by the faculty or staff member’s departmental funds and/or sponsoring unit.
Printed Name of Department Chair/Director: ______
Signature of Department Chair/Director: ______Date: ______
Printed Name of Academic Dean (or designee): ______
Signature of Academic Dean (or designee): ______Date: ______
INTERNATIONAL TRAVEL ADVISORY COMMITTEE REVIEW
This trip has been reviewed by the International Travel Advisory Committee (ITAC) in regards to the significant health, safety, and liability issues that exist when students go abroad as part of a University of Michigan-Flint faculty led experience.
Based on this review:
This trip has been approved
This trip has been approved with modifications (refer to attached letter)
This trip has been denied (refer to attached letter)
______
Maureen Tippen, ITAC Chair Date

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219 University Center  303 E. Kearsley Flint MI  48502  810-762-0867  fax 810-762-0006 