Medical Evacuation and Repatriation Insurance Form

(*) denotes required information.

Gettysburg College employees who are traveling abroad for college-related business are eligible for the medical evacuation and repatriation travel insurance coverage which is covered by the College. Immediate family members (spouse/partner, children 26 and under) traveling with employees on college related business may also purchase this same coverage for $1.33 per day or $233.00 per semester.

Students traveling abroad on research or short -term projects may also purchase this insurance for $1.33 per day or $233.00 per semester.

No personal travel will be covered under this insurance for employees or family members. If you are looking for insurance for personal travel, visit the Roam Right website .

If you require assistance to complete this form, please contact our office for advice (x6866,

NOTE: If you are the sole participant in this international activity, this is the only information required. If you are being accompanied by Gettysburg College students, please continue with the following questions.

Is it possible to register the names of group members and the official itinerary with the Embassy or Consulate?

NOTE: All students will need to complete the Agreement and Release form in order to participate in this international activity.