CAP Travel Authorization form

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Personal information

    Flight information

      MM slash DD slash YYYY
      MM slash DD slash YYYY

      Consent information

        Please check the boxes below to agree to the terms and conditions:*
        • I confirm that my travel dates do NOT conflict with my internship/training schedule.
        • I understand that submitting this form does not guarantee that Greenheart Exchange has authorized my Request for International Travel.
        • I understand that I am to receive Greenheart Exchange’s approval for my travel request before making flight arrangements.
        • I am aware that, if my international travel is approved, I will be asked to mail my original DS-2019 form to Greenheart Exchange’s headquarters in Chicago for signature.
        • I agree to pay $20 to Greenheart Exchange to cover return shipping of the DS-2019, and understand payment can be made by credit card, check, or money order.
        • I understand that Greenheart Exchange permits one travel authorization for programs up to 12 months long, and 2 for programs up to 18 months long. This excludes emergency situations that require travel abroad.