International Travel Registration Form

International Travel Registration form

First Name: Required Field

Last Name: Required Field

Primary Email: Required Field

H Number

University Affiliation Required Field

Do you live in on-campus housing? Required Field

Do you live in on-campus housing? Yes
No

Where are you currently traveling or planning to travel? If other, please specify the location outside the United States. Required Field

Please describe your travel plans. Include U.S. departure date, date(s) of departure from each country, U.S. arrival date and locations visited (city and country). Required Field

Is your travel for personal reasons or for a university business-related or university-sponsored purpose? Required Field

Is your travel for personal reasons or for a university business-related or university-sponsored purpose? Personal reasons
University business-related
University sponsored

Do you intend to return to the University after your travel? Required Field

Do you intend to return to the University after your travel? Yes
No

Are you experiencing any form of illness, in particular fever, cough, or shortness of breath? If yes, please describe your symptoms.

For faculty and staff, please identify your department chair or supervisor.

Supervisor Name

Please identify an emergency contact outside the University.

Name

Relationship

Email Address

Phone Number Required Field

I have read and understand HBU’s requirement that I must self-quarantine for 14 days following any international travel. Required Field

I have read and understand HBU’s requirement that I must self-quarantine for 14 days following any international travel. Yes
No