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STUDENT EMERGENCY ACTION PLAN (Webster University)

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STUDENT EMERGENCY ACTION PLAN
Hybrid Travel Course
Student Name: __________________ Date of Birth: ______________
Citizenship: ____________________ Passport #: _______________
Visa (Country & # if applicable): ______________________________
Student Phone # while travelling: ______________________________
Student E-mail while travelling: ________________________________
Blood Type: ______Allergies: _________________________________
Special Medical Conditions: ___________________________________
Medications: _______________________________________________
Wishes in event of serious injury/death: _________________________
_________________________________________________________
Program Title: _________________________________
Emergency Contact Information
Location 911 Equivalent
________________________
Office of Study Abroad
800-984-6857
worldview@webster.edu
WU Public Safety
314-968-6911
Program Emergency Contact
________________________
________________________
________________________
Personal Emergency Contact
Name: __________________
Home #: _________________
Cell #: ___________________
Office #: _________________
E-mail: ___________________
Nearest US Embassy/Consulate
Phone #: __________________
E-mail: ____________________
Address: __________________
___________________
___________________
Travel Information
Arrival Carrier/# : __________________________
Arrival Date/Time : __________________________
Departure Carrier/# : ________________________
Departure Date/Time : ________________________
Student Information
Insurance Information
Personal Medical Insurance
Carrier/policy #: _____________
Phone #: ____________________
Nearest HTH Hospital Abroad
Phone #: ____________________
Address:_____________________
____________________________
HTH International Health Insurance
Inside the US: 1-888-243-2358
Outside the US: +1-610-254-8769
Webster University Policy Plan ID:
Webster Univ–Study Abroad
Note:
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STUDENT EMERGENCY ACTION PLAN (Webster University)

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Completed 2 February 2021

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