Faculty-Led Overseas Program Application

Please download the following PDF files, fill them out and upload them after scanning. You will upload them at the end of this form. Also, you will need a clear image of the front page of your passport. The image should clearly display your photo, date of birth and passport number.

Demographic Information

Program: Faculty Led Destination *

Term *

Each year, the U.S. Department of State asks American universities and colleges like YSU to provide information about study abroad students. They ask for demographic information about students to help understand which students are studying abroad and to encourage students from all backgrounds to participate. Completion of this form is optional.

Traveler Information

First Name *

Last Name *

Sex *

Pronouns

Race

Ethnicity

Disability

Veteran Status

Emergency Contact Information

Traveler Information

First Name *

Last Name *

Primary Emergency Contact

Emergency Contact Name *

Emergency contact's relationship to you (mother, father, spouse etc.) *

Emergency contact's cell number. Enter none if your contact does not have a cell phone. *

Emergency contact's home telephone number. Enter none if your contact does not have a home telephone number. *

Emergency contact's work number. Enter none if your contact does not have a work telephone number. *

Emergency contact's email. Enter none if your contact does not have an email. *

Emergency contact's full home address. *

Secondary Emergency Contact

Secondary Emergency contact name *

Secondary emergency contact's relationship to you (mother, father, spouse etc.) *

Secondary emergency contact's cell number. Enter none if your contact does not have a cell phone. *

Secondary emergency contact's home telephone number. Enter none if your contact does not have a home telephone number. *

Secondary emergency contact's work number. Enter none if your contact does not have a work telephone number. *

Secondary emergency contact's email. Enter none if your contact does not have an email. *

Secondary emergency contact's full home address. *

GeoBlue Roster Form

First Name *

Last Name *

Email (Use YSU's email) *

Date of Birth *

Year

Month

Day

Telephone/ Cell Number * +1

Gender *

City *

State *

Zip Code *

Home Country *

USA

Host/Destination Country *

Host City *

Insurance Coverage Form

Traveler Information

First Name *

Last Name *

International travel and medical insurance is required for all YSU study abroad participants. YSU requires students on independent study abroad programs to purchase comprehensive international travel and medical insurance, including medical evacuation, to cover the student while outside the USA. Students participating in a direct exchange program are required to purchase the study abroad insurance offered by the International Programs Office.

I understand and agree to obtain the required insurance. *

Yes

By typing my name and the date in the box below, I confirm that I have read and understand the insurance policies stated above.

Please type your name and enter the date here. *

Pre-Departure Orientation Session

All study abroad students are obligated to attend a mandatory pre-departure orientation session to discuss study abroad requirements and safety and security abroad.

First Name *

Last Name *

Confirmation of Attendance

I have attended a Study Abroad Pre-Departure Orientation Session (click yes once attended). *

Please list the date you attended a Pre-Departure Orientation Session. *

Year

Month

Day

Upload the completed froms

Medical Self Disclosure Form *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Passport Form *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Please upload a clear image of the front page of your passport. *

The image should clearly display your photo, date of birth and passport number.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Statement of Responsibility *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Leave this field blank

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