International Business Travel Insurance Form

All Appalachian State University employees traveling abroad on official university-related business must enroll in the International Business Travel Insurance plan.

If you are a student, this is not the insurance you need.

Submit this form, as well as an Official Travel Authorization, passport copy, and any payments for dependents, to enroll.

Personal Information
IMPORTANT: OIED will use this email address to send you your GeoBlue card as an email attachment.
Travel Information
This can be your hotel, a University, conference location, etc. This will be given to GeoBlue should an emergency arise during your trip.
Type of Coverage Requested:

If you enroll a dependent, you must fill out all applicable information and calculate your payment. Multiply the daily dependent premium by the number of travel days (including days of departure from and return to the U.S.). Further instructions on payment are included in the confirmation when form is submitted.

You are financially responsible for insurance premiums covering any accompanying dependent(s) not on "official business" travel with Appalachian State University. Please note that coverage for dependents is not required, but strongly recommended.
Dependent 1 Information
Dependent 2 Information
Dependent 3 Information
Emergency Contact- U.S.
List one contact in the U.S. OIED may contact in case of emergency.
Emergency Contact - Overseas 1
List one contact abroad OIED may contact in case of emergency.
Emergency Contact - Overseas 2
List one contact abroad OIED may contact in case of emergency.
Emergency Contact - Overseas 3
List one contact abroad OIED may contact in case of emergency.
I agree to follow all University policies and procedures on obtaining international travel insurance and complying with export control regulations. Any Appalachian State University employee who travels abroad without having completed both the Travel Authorization and the International Travel Insurance forms personally assumes full responsibility for health and safety, and such failure to comply with procedure may result in denial of Travel Reimbursement expense.
Passport Copy and Travel Authorization Copy