Questionnaire – J and K Worldwide

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Italy 2026 Questionnaire

Contact info

Let's get to know you!

Full Name (as it appears on your passport):

Preferred name (if different):

Gender:

Male

Female

Other

Other gender:

Date of birth

Email

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone number:

Passport info

Are you ready to travel?

Citizenship Country:

Passport number:

Passport expiration:

→If you currently don’t have a valid passport, OR if it will expire within three months of the tour, please apply for one now.

Eastern Michigan University

Connection to EMU:

Alumni

Faculty Emeritus

My Co-traveler is one of the above

Other

As an EMU student, what year did you graduate, or last year of attendance?

If your connection is something else, let us know!

EID# (EMU ID Number, if applicable):

Health & Ability

Any allergies we should be aware of?

Any medical concerns we should be aware of?

Any mobility concerns (walker, wheelchair, etc.)?

Do you currently have medical insurance that will cover you overseas?

Yes

No

Not sure / other

Do you want to tell us more about your medical insurance situation?

Accommodations

Accommodation occupancy plans

Double occupancy with my co-traveler

Single occupancy

Please help me find a roommate

Bed type preferred by you and your co-traveler?

2 Beds

1 Shared Bed

Roommate/Co-Traveler's name:

Single occupancy adds $900 to the trip cost.

I understand that if a roommate is not available I will be responsible for a single occupancy room, which adds $900 to the trip cost.

I understand that next I have to sign the legal waiver and send in my deposit money before my spot will be reserved.

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