International Travel Pre-Departure Attestation

Please complete the information requested below.

First name: *

Last name: *

UNI: *

Mobile phone while traveling: *

Role at the Law School: *

List the destination(s) included in this Columbia-related international travel itinerary. *

Approximate start date of travel: *

Approximate end date of travel: *

Travel Risk Assessments

Is your itinerary listed on the CU Travel Advisories website? *

Yes

CU Travel Advisories

What is your itinerary's highest risk on the ISOS travel security page? *

ISOS Travel Security

What is your itinerary's highest risk on the DOS travel advisories page? *

DOS Travel Advisories

Group Travel (please answer ├óÔé¼┼ôN/A├óÔé¼┬Ø if not applicable)

What is the name of this group? *

Who is the group leader? *

If you are the organizer/leader, are you traveling with the group? *

Yes

N/A

If you are the organizer/leader, who are the group members? *

If you are traveling, whom do you authorize Columbia University to contact in case of emergency?

Name: *

Relationship to you: *

Phone: *

Email: *

Attestation

I am organizing, leading and/or traveling on the Columbia-related international travel summarized above.

I confirm that, prior to the departure date, I will comply (and, if organizing and/or leading a group, ensure that group members comply) with all of the applicable requirements listed on the International Travel Pre-Departure Requirements website. *

Signature

Dated: *