Extended Stay Release

Student Information

This form is for students who are participating in a GRCC Study Away experience and want to extend their stay beyond the dates of the trip.

First and Last Name

Student ID

No "W". Example: 0123456

What Study Away trip are you attending.

Reason(s) why you want to extend your stay.

When do you plan to return back to Grand Rapids, MI?

Please put the date you plan to leave.