CISI Registration

CISI Registration Information

Your trip overseas is quickly approaching. Gordon College requires all students who are going abroad through a Gordon program to be enrolled with CISI (Cultural Insurance Services International). Please complete the form below as quickly as possible so that we can enroll you. CISI provides both primary and emergency medical coverage, as well as emergency and medical evacuation should that be necessary. If you have any questions, please contact [email protected].

1. Last Name

2. First Name

3. Gender

	Male
	Female
	Unknown
	Diverse

4. Birth date (MM/DD/YYYY) Please use slashes, not hyphens and 2-digit month/2-digit day/4-digit year.

5. Start Date of Program (MM/DD/YYYY) Please use slashes, not hyphens and 2-digit month/2-digit day/4-digit year.

6. End Date of Program (MM/DD/YYYY) Please use slashes, not hyphens and 2-digit month/2-digit day/four-digit year.

7. Your Country of Origin

8. Country of Destination (if you are going to more than one destination like the Greece seminar which goes briefly to Turkey, please identify the primary destination here)

9. Destination City Name: required field (up to 256 characters alllowed). If you are going to multiple cities, please separate each destination by a comma.

10. Sponsor Program Name (i.e.Orvieto, Balkans, Best Semester - Oxford, CIEE- Spain, Faculty/Staff travel, etc.)

11. Email Address (please use the email address at which you would prefer CISI to send email to you.)

12. Phone Number (preferred number for being contacted by CISI)

13. By using this form you agree with the storage and handling of your data by the Cultural Insurance Services International (CISI) website in accordance with their Privacy Policy: https://www.culturalinsurance.com/cisi_privacy.asp

Yes

14. Gordon program you are requesting CISI for: