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Office of International Programs


Office of Study Abroad


ODU International Health Insurance Coverage Certification Form

Please fill out the following form. Print the form, sign and date it, and turn it in with your payment to the Office of Study Abroad.

Following submission of this form, please allow 10 business days for processing.

Old Dominion University policy #5101 requires that all students, faculty, administrators and staff participating in international education abroad initiatives -- whether of a credit or non-credit nature -- carry complete international health insurance coverage for the duration of their program.

Name:
UIN:
Program Name:

DOB (mm/dd/yyyy)

Telephone #

Email Address

Physical Address

I certify that I will attend one of the common programs listed on the health insurance price list. The amount listed for that program is

I certify that the program in which I will participate includes international health insurance coverage satisfying ODU's International Health Insurance Coverage Requirements for Study Abroad

I certify that I will attend a study abroad program that does not include international health insurance coverage satisfying ODU's requirements.

  • My program start date is:
  • My program end date is:
  • My total program days are:  
  • Including two travel days, I need  days of international health insurance coverage.
  • At the current rate of per day, my international health insurance will cost:

         

Total Health Insurance Cost:

I understand that, unless specifically exempt, I am responsible for purchasing international health insurance coverage through the ODU Office of Study Abroad at the above cost.

Student Signature:___________________________________________

Date:______________________________________________

 



News and Announcements

The Office of Study Abroad has moved!

Spring 2012 Study Abroad Fair!

Science Summer Research Grant Program in Tokyo: UTRIP

Spring Break and Summer Programs for 2012!

Information Sessions

Study Abroad Deadlines

Study Abroad in South Africa Helps ODU Staff Member Realize Lifelong Dream

NEW Counseling Study Abroad Programs Announced for 2012!





Resources

How to Fund Your Study Abroad Experience

Student Fellowships for International Study/Research

Passport Application Information

Travel Information

CDC Travelers' Health Information

Digest for Student Funding/ Job Opportunities and Conferences

International Career Advantage Program

Forms





Media Gallery

STUDY ABROAD: ODU students speak on their experiences

View ODU students' photographs from abroad

Student blog: Michelle Tisch at the University of Leicester

Student blog: Stephen Benkert in Melbourne, Australia

Thomas Keane on Semester at Sea in Gibraltar, Spain

See a YouTube video of one study abroad student's experience





About Study Abroad

Mission Statement

Frequently Asked Questions

Interest Form

Contact Us

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