Resident Member Travel Itinerary

Please complete this form prior to your departure. The Admissions Office will reply with details regarding your quarantine requirements based on your travel itinerary.

* = Required Field
Name*
First Last
I-House Room Number
Email*
Phone*
Departure Date*
What date will you leave I-House for your trip?
Date Format: MM slash DD slash YYYY
Return Date*
When will you return to I-House?
Date Format: MM slash DD slash YYYY
Where are you going?*
Please list all places you will visit during your trip. Be certain to include the country, city, county, state or province and how long you will be in each place. Click the plus sign to add more destinations.
City State or Province Country Length of stay (in days)
Travel Itinerary
If you are travelling by airplane please provide a list of all airports you will be travelling through, including stops and layovers.
Country City Airport
Emergency Contact Information
Emergency Contact Name*
First Last
Relationship*
Emergency Contact Phone*
Emergency Contact Email*
Should you need to quarantine, based on your travel itinerary, please know that I-House will support you in doing so by providing a space and ensuring that you receive delivery of food, mail and packages and that garbage is removed from the apartment you are staying in for quarantine.
Consent*
I have read the policy (link to the policy) and agree to quarantine for the length of time specified in the policy based on my travel itinerary.
I have read and agree

City	State or Province	Country	Length of stay (in days)

Country	City	Airport

Emergency Contact Information