EF Gap Year participants are required to complete and return this health form before they are cleared to travel on their program. Note that if you have been treated for any significant physical and/or psychological condition(s) within the past 12 months, your healthcare provider(s) must also complete the appropriate section(s) below. Prior to departure, you must leave a sealed copy of this form with both of your designated emergency contacts. Information provided may be shared with relevant EF staff, as needed. Throughout your program abroad, you must carry a copy of this form with you at all times. You must also notify us immediately (in writing) if there are any changes to the information provided in this form.