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
Travel Information
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.
Dependent 1 Information
Dependent 2 Information
Dependent 3 Information
Emergency Contact- U.S.
Emergency Contact - Overseas 1
Emergency Contact - Overseas 2
Emergency Contact - Overseas 3
Passport Copy