VIU

Education Abroad Registration Form


Note:  Highlight  indicates the required fields
PROGRAM AND DESTINATION COUNTRY

PARTICIPANT INFORMATION
First & Last Names (Exactly as they will appear on you passport):
Given Name Middle Name(s) Family Name

What name do you go by? 

Sex
If the gender on your travel documentation (passport) differs from the gender you identify as, please select the gender option as matching your documentation. In an emergency situation, VIU may need to book flight itineraries on your behalf. If the flight is booked with a gender that is different than what is in your travel documents, they may refuse you to board the flight.

  Year-
2016
Month-
JAN
Day-
23

Current Mailing Address:
# Street City Province
Country Postal Code
Email Address
Best Phone# to Reach You:
Cell Phone:
If you become aware of any reason that might hinder your ability to travel internationally (academic performance, conduct sanctions, criminal convictions), please contact the Education Abroad Office to discuss how this might impact your ability to participate in this program.
Have you ever been convicted to a criminal offence for which you have not been pardoned?   
May we release your name and email address to other participants in your study abroad program?   

PASSPORT
We require a copy of the information page for our file. If you don’t have a valid passport, submit this registration form and provide us with a copy of the information page of your passport when you receive it.
Year-
2016
Month-
JAN
Day-
23
Are you applying for a new passport or renewing your passport?
Your passport must be valid for six months past your intended date of return.

International Students:
Year-
2016
Month-
JAN
Day-
23
Year-
2016
Month-
JAN
Day-
23
 

International students must ensure they have a valid study permit for the duration of their participation on a VIU international activity. A valid study permit is required by IRCC for international students participating in any educational opportunity facilitated by VIU regardless of if the program is delivered in Canada. If your study permit expires outside of Canada, you will be denied re-entry into Canada until you have successfully renewed your document.

MEDICAL INSURANCE
It is the participant's choice to purchase Global Plan A or Global Plan B. Global Plan A includes cancellation and interruption insurance. It is your responsibility to also ensure that they have appropriate medical coverage in Canada in the event that you require medical care in Canada as a result of your participation in an Education Abroad activity. If you do not have a current provincial health plan, your emergency travel medical insurance may not be valid.

Purchase your Guard.Me Insurance through the VIU portal: https://www.guard.me/viuoutbound


EMERGENCY CONTACTS
Emergency Contacts: Relationship: Phone Number: E-Mail: Country of Residence:
1.
2.

VIU

Education Abroad Self-Assessment


Your health and safety are important to us. By completing this section you help us to understand any health or accommodation issues that we should take into consideration before you go abroad. This information will help us plan for any supports you may need, or anticipate any potential difficulties that you may encounter abroad. The information you provide in this section will be used as a guide and will only preculde participation if essential care is not available at the foreign site or if appropriate accommodations cannot be made by the partner institution or on the field school.

The pressures of living and studying in a foreign country are considerable. Even mild physical and mental health issues can be exacerbated by local conditions, the stress of cultural adjustment, and differences in medical practices. In some countries, sanitation and medical facilities may be inferior to those enjoyed in Canada, and medical attention may be hours or days away.

Should you develop a health problem between the time you complete this form and begin the overseas program, promptly notify the Education Abroad Manager (Jennifer.Sills@viu.ca or 250-740-6312) since your out-of-country medical insurance may no longer cover you.


Medical:
Do you receive onging medical treatment or take presciption medication for a health condition which may affect your ability to participate in this program? If yes, please describe
(3000 of 3000) Remaining
 
Do you have any severe allergies that may affect your ability to participate in this program?
(3000 of 3000) Remaining
 
I have an ongoing medical condition, been advised to have surgery, or take prescription medication.
Have you confirmed with Guard.Me that you will have coverage in the event you need to seek medical attention abroad for your pre-existing condition?
Have you consulted with your family doctor or GP that you are okay to participate in an international travel and study experience?
Have you spoken with the faculty leader or Education Abroad about planned activities for your international activity for which you maye need support or accommodations in place? Please note that accommodations may not be able to be put in place for all aspects of a field school depending on the nature of the activity.
It is my responsibility to schedule a confidential meeting with the Education Abroad Office or Disability Access Services should I have any concerns related to health or accessibility of this program.
 
Access:
Are you currently registered with Disability Access Services? If yes, have you contacted them to discuss participation in this program and any accommodations you may need while abroad?
(3000 of 3000) Remaining
 
Living and studying abroad can be significantly different from living and studying in Nanaimo. Do you anticipate any difficulties or challenges that may impact your ability to be successful in this program? If yes, please provide a brief description.
(3000 of 3000) Remaining
 
Acknowledgements:
Please Read The Following Before Submitting
  1. It is my responsibility to learn as much as possible about the risks of the venture, to weigh these risks against the advantages, and to decide whether or not to participate.
  2. I certify that all statements made on this registration form and the self-assessment form are true and correct. I understand that misrepresentation of this information in any material way may result in my being withdrawn from the education abroad program. For those programs where I am paying program fees to VIU, I have read and agree to the cancellation and refund procedure.
  3. I agree to abide by the rules and regulations of Vancouver Island University.
  4. The information on this form is collected under the authority of The University Act (RSBC 1996 Ch. 468). The use of this information will be in compliance with the Freedom of Information and Protection of Privacy Act. Any questions concerning the collection and use of this information should be directed to the manager at the address above.
  5. I understand that my passport must be valid for a minimum of 6 months after the conclusion of travel. If I am refused travel by a travel provider (airline, train company etc) or immigration official because my passport is expired or will expire before the end of my program, I will not be eligible for a refund of fees I have contributed towards the field school. I understand I may not be able to complete coursework associated with this program if I cannot participate in the travel component of the experience.