Education Abroad Emergency Contact Form

Please provide contact information for use by UMW Department of Public Safety or The Center for International Education in the event of an emergency during your travel overseas. This information is confidential and will not be shared or distributed by UMW.

Your Name*
First Last
Email*
Banner ID
Emergency Contact Phone*
Your US cell, or international cell number if you have one (include country code for international numbers.)
Program*
What is the name of your Education Abroad Program? (e.g. - Rugby Team trip to Ireland, UMW Philharmonic Italy tour, or Individual Research)
Program Start Date*
Program End Date*
International Contact Information*
Please list contact information for each place you will be staying while abroad and dates for each destination. If your program has on-site staff, please provide contact information.
Captcha
Name
First Last

Education Abroad Emergency Contact Form

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