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Home » Academics » JanTerm » Travel Jan Term | Medical Release and Info

Travel Jan Term | Medical Release and Info

All students traveling off-campus for Jan Term must complete this form. You may instead choose to fill out the form in person by visiting the Study Abroad office located at WCC 204.
  • PERSONAL INFORMATION

  • Some countries recognize non-binary gender on the passports they issue. Please choose the gender your passport has listed for you.
  • Your passport must be valid six months AFTER THE DAY YOU RETURN. If you need to renew your passport or apply for a new one, please go immediately to the Study Abroad office (WCC 204), and they will help you with the process.
  • Please upload a photo of the main page of your passport. (If unable to do this here, you must provide a copy to the Study Abroad office - WCC 204.)
    Accepted file types: jpg, gif, png, tif, pdf.
  • PERSON TO NOTIFY IN CASE OF ILLNESS OR INJURY

  • MEDICATIONS AND MEDICAL INFORMATION

    For your safety, if you have any medical condition that the Study Abroad office and/or faculty sponsor should be aware of, please provide the information below:

  • Please indicate any chronic health conditions or other health situation the Study Abroad office and your professor should be aware of.
  • Please provide additional relevant information about your health situation.
  • AUTHORIZATIONS AND AGREEMENTS
  • INSURANCE: Austin College students studying abroad during January Term are required to have medical, medical evacuation and repatriation coverage while out-of-the-country. Austin College has arranged for group coverage, and the cost of the coverage has been included in the total course fee billed to the student.

  • I understand that typing my name in this box and submitting this form constitutes a legal signature and that the information provided here is true to the best of my knowledge.

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