UT Dallas - Program Name

Instructions to fill out this form.

Examples of what information is needed have been provided for your convenience in some fields and arehighlighted in blue. Please delete them from the final document.
Italics without highlight provide instructions on the type of information needed in that field. Please delete instructions once the field is filled out.
Submit this form for review to

Sponsor: name/title/area | e-mail: | 24/7 phone:

Secondary UTD contact: name/title/area | e-mail: | 24/7 phone:

Program Justification Letter

Dear IOC Committee Members,
Please enter herearguments in support of the academic purpose, goals, and value of the program. Rationale for operating program in a country subject to a U.S. Department of State Travel Warning, or that requires IOC risk authorization () and why the International Oversight Committee should support this program moving forward. Please delete these instructions from the final document.
Please leave statements below and deletethese instructions from the final document.
I understand and accept that in the event of approval, the University retains the right to withdraw approval and/or require return of the travelers to the U.S. This may occur if there is a change in the proposed itinerary, the critical nature of the trip, or the health/safety/security climate of the region of interest.
I understand and accept that the University reserves the right to withhold reimbursement and/or take other disciplinary actions for noncompliance with the University International Travel Authorization process.
Signature of the Sponsor / Date

Overview of the Program

Brief Description of the program / Clearly address whether this is intended to be a one-time offering or a recurring opportunity, and indicate if academic credit will be awarded, where the program will be based, academic/professional network, whether the program is mandatory or not. Target population for the program.
Ex. Student exchange program, with an expected enrollment of one-to-one academic exchange basis with up to 6 full-year places or 12 one-semester places available each year with Name of School in Country. # of locations. Campuses: City, City, City. UTD staff stationed/not stationed on-site. This program is/is not mandatory. Target are UG and/or GR students.
Program length / enrollment times / Ex. Long semesters, potentially to be include summers.
Arrival / Departure logistics / Ex. Students responsible for own transportation, unless matched with Home Stay program (family will pick traveler)
Day to Day Transportation / Ex. Public buses. Expreso buses from campus to host recommended neighborhoods. Host recommended Taxi service. UBER. Taxis from the street not recommended.
Housing options and their security elements / Ex. Home Stay program. Vetted by host.
Ex. Residence Halls. Inside campus premises. 24/7 surveillance.
Ex. Off Campus. Not vetted by host. Assistance provided to find a place.
Security of program facilities / Ex. 24/7 security system. ID required for entry. Campus delimited by gates and fences. Security guards.
Medical/Emergency Facilities / Ex. Medical Services Department staffed with 2 medical doctors and 5 paramedics. Fully equipped with a Code 3 emergency room which can be used to attend patients under critical conditions. Hours of operation are Mon-Fri from 07:00 to 22:00 and Saturdays from 08:00 to 17:00.
Hospitals:
Ex. Centro Médico Puerta de Bronze. 21 min from campus to hospital.
Ex. Hospital San Javier Ixtalamar. 21 min from campus to hospital

Safety and Security: Existing measures from the on-site program, proposed measures from the Sponsor, and support from the International Center Education Abroad and Risk and Safety departments, that would mitigate concerns identified by International SOS (ISOS)case # and the U.S. Department of State Travel Warning.

On-Site institutional support / Ex. Pre-departure electronic handbook w/information to prepare for arrival, house search, etc. Newcomers’ orientation: safety tips, instructions on what to do in case of emergency.
On-site Emergency Response Plan
Int’l Programs Office (IPO) / Ex. IPO official trips are accompanied by a paramedic. Students can contact 24/7 the IPO or campus security. Emergency Response Committee assesses the situation and take proper actions. Host will reach out to students through different media: phone, e-mail and social media. Communication with partner universities involved is established for notification and follow up.
Program Risk Mitigation Strategy / Describe the policies and measures the program will take for mitigating the specific security risks identified by International SOS and the U.S. Department of State. Examples of such measures might include avoiding travel to certain neighborhoods in a city or regions within a country, using only specific means of transportation, not traveling alone after dark, etc. Contact International SOS and speak with a security expert for the country or region where the program will take place. Include the International SOS Case # and Travel Security Brief.
Pre-Departure Safety Awareness – Health, Safety and Security
PDO (Pre-Departure Orientation) / Pre-Departure Safety Awareness – Health, Safety, and Security. Describe how pre-departure health, safety, and security information will be provided to program participants and what content will be included, including the following required items:

International SOS (ISOS) Travel Security Briefing. Provide the most current ISOS security briefing for the program. ().
Travel Warnings, Alerts, Notifications. Provide the full content of the most current:
US Department of State Travel Warning / Alert.
CDC Travel Notice.
ISOS general Overview of the country and city specifics if available.
ISOS How tos. . Provide, at pre-departure and in print materials, instructions on how to:
Enroll and register trip in ISOS.Contact ISOS for travel and emergency assistance.
How to print the ISOS card.
Download and use the ISOS Assistance App.
Smart Traveler Enrollment Program (STEP). Encourage U.S. Citizens to register with the Smart Traveler Enrollment Program (STEP). . Encourage Non-US citizens to follow any similar guidance provided by their country of citizenship.
Student International Travel Accident and Sickness Policy. Provide students with a copy of the most current brochure. Advise them to review benefits, and exclusions and limitations.
Voluntary Participation in Travel. Include in pdo and printed materials the full content of the Liability Disclaimer as applicable.
University Risk Notification Statement. Include in pdo and printed materials the full content of the Risk Notification Statement (see last page of this form).

Pre-Departure Safety Awareness – Cultural Difference / Pre-Departure Safety Awareness – Cultural Awareness Differences of religion, cultural norms, local traditions, and political attitudes can present challenges that may affect a student’s health and safety while studying abroad. During pre-departure and on-site orientations, how will students be informed to modify their behavior to address these cross-cultural differences? Describe in detail here.
UTD Contingency Plan in case of evacuation / Explain what the sponsoring academic unit will do in the event the University decides to recall (or evacuate) the program early due to heightened risks to health, safety, or security. This should include contingencies regarding academic concerns, participant housing, program relocation, etc.
Option to Withdraw at any time / No student, faculty, or staff can be required to travel to a High Risk Region. Describe how an option has been incorporated into the project plan for participants to withdraw from participation in this program at any time. Indicate how this option will be clearly communicated to travelers.

Communication

On-Site 24/7 Emergency Contact / Ex. Gabriel Robles
Example University International Programs Office Director
Cell +52 1232004567 available 24/7
UTD Sponsor and Secondary 24/7 Contact / Sponsor: name/title/area | e-mail: | 24/7 phone:
Secondary UTD contact: name/title/area | e-mail: | 24/7 phone:
U.S. Embassy/Consulate Contact / Ex. U.S. Consulate Guadalajara
(off hours): 011-52-55-1234-6789, ext. 0 (from the U.S.); 01-55-1234-6789, ext. 0 (from Mexico)
Cell Phone Requirement / Address whether or not participants will be required to have a working cell phone while on the program. If required, include where the full list of participant cell phone numbers will reside and how information will be communicated to participants in an emergency. If participants are not required to have a cell phone, address how anticipated communication challenges will be met.
Trip Registration: STEP Program and ISOS. / Registration in the U.S. Department of State STEP program is encouraged and responsibility of the travelers. This program is only available to U.S. Citizens. Other country nationals are encouraged to follow similar guidance provided by their country of citizenship. All travelers, regardless of nationality, are required to register their trip in ISOS prior to departure.
Address how will trip registration recommendations and requirements will be communicated to travelers:Ex. will be included in the program information, and highlighted in advising sessions and pre-departure orientations.

Risk Notification Statement

The University must review international travel to destinations considered High Risk Regions, as determined by the International Oversight Committee. Travel to any High Risk Region involves certain degrees of risk. It is important that travelers UNDERSTAND & CAREFULLY CONSIDER THE FOLLOWING RISKS:

The US Embassy nearest your destination may temporarily close or suspend public services for security reasons.
The US Embassy nearest your destination may not be able to provide emergency assistance should you require it.
If there is a need to evacuate in an emergency, flights may be suspended and other departure or shelter options in place may be limited or non-existent.
Access to hospitals, emergency medical care and medications may be limited or non-existent.
Should you experience difficulties, the University and their contracted emergency assistance provider, International SOS, may not be in a position to provide emergency assistance to you.
Participation in travel to a High Risk Region has inherent risks which may include kidnapping or death. These risks can never be completely eliminated.
Risks of travel to your destination may include (but are not limited to) dangers to health and personal safety, including possible death posed by natural disaster, disease, terrorism, crime, civil unrest, and/or violence.
Additional risks include (but are not limited to) minor and major physical injuries, emotional and psychological injuries inflicted accidentally or intentionally by others, and/or catastrophic injuries, including paralysis and death.
There may be additional health, safety, and security factors that have not been brought to your attention by the University.

IT IS HIGHLY RECOMMENDED THAT YOU VISIT & CAREFULLY REVIEW THE FOLLOWING WEBSITES:

High Risk Regions to determine if your destination requires additional risk level authorization or has specific requirements.
International SOS website (member ID: 11BSGC000037). Risk and safety information for your destination.
Learn about your destination's medical and travel risk rating.
Learn about road safety at your destination.
US Department of State website for Travel Warnings, advisories, and consular information sheets for the intended destination.
US Centers for Disease Control and Prevention website for information on health issues and recommended vaccinations for your destination.
World Health Organization website for information on disease outbreaks and emergencies
Travel advice for: Road Safety. Floods. Water Activities and the Risk of Drowning. Creating a Personal Emergency Action Plan. Traveling with Medications. Sexually Transmitted Infections (STIs). Traveling with Electronics. Alcohol and Drugs Abroad. Food and Water Safety. Women Travelers. General Safety and Security Tips for Travelers. LGBTQA Travelers, others as added.