Extended Stay Release

Student Information

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

Student Name
Student ID

No "W". Example: 0123456
Study Away Program you are attending.
Reason(s) why you want to extend your stay.
Do you plan to leave prior to the official start date of your Study Away experience?
If yes, please enter your departure date below. If no, respond: N/A.

Please put the date you plan to leave.
Do you plan to return after the official end date of your Study Away experience?
If yes, please enter your return date below. If no, respond: N/A

Please write a date.