International Visits

Dear Friends:

We are delighted that you will be visiting the Maryland Province. To assist you with planning, we ask that you provide us with some information regarding your visit. Please fill out and submit the form below. A member of the Province staff will contact you to confirm your plans and respond to your requests. We look forward to your visit!

Thank you.

 
Name: Date:
Resident Province Status:
Email:
Date of Arrival: Date of Departure:
Reason for Visit:
Main Residence in the U.S.
Address: City:
State: Zip Code:
Phone:
Contact Person:
Relation:
Host Jesuit Community: Confirmed: Yes    No
Health Services
Do you anticipate needing any
medical attention?:		 Yes    No
If yes, briefly describe:
If you anticipate uncovered medical expenses,
have payment arrangements been made?
Other Support Services
Please list flight arrival information:
Would you like to be picked up
at the airport?		 Yes    No
Please list flight departure information:
Would you like to be dropped off
at the airport?		 Yes    No
Do you need a car during your stay? Yes    No
Dates needed:
Would you like to request a stipend? Yes    No
Will you be engaging in public ministry
during your stay?		 Yes    No
If yes, briefly describe:
Emergency Contacts
Name of US Contact: Phone Number
Name of Contact Abroad: Phone Number