Medical Information-Emergency Contact Form for Inbound International Students and Scholars

Traveling to a different culture and environment can pose emotional and physical challenges. It is important that you discuss with a medical provider any past, current or potential medical conditions to prepare you for your program at UMF and allow us to assist you with any necessary accommodations requests.

The information requested in this form is necessary to identify any medical precautions that are recommended and to provide critical medical information in the event that a health problem or other emergency arises while you are at UMF. The information provided will remain confidential, reviewed only by the Office of Global Education and medical personnel in case of an emergency while on your program.

If you have any questions, please contact Lynne Eustis, Assistant Director of Global Education leustis@maine.edu

Email *
First/Given Name *
Last/Surname
Date of Birth *
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Period of Study/Teaching at UMF (e.g: Fall 2024, Academic Year 2024-2025, Fall 2024-May 2028) *
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