Study Abroad Petition Form Explore this Section Please visit the Study Abroad homepage for more information. First Name Last Name Student ID Student Email Gender Date of Birth Permanent Address Permanent Street Address Permanent City, State, ZIP Permanent Phone Current Address (if different from Permanent Address) Current Street Address Current City, State, ZIP Current Phone Use current address until: __________ Ethnicity (optional) Citizenship Citizenship U.S. Permanent Resident Other (indicate below) Other Citizenship (if applicable): Passport # Date City and Country of Destination Sponsoring University Street Address of Sponsoring University/Program City, State, ZIP of Sponsoring University/Program Phone Number of Sponsoring University/Program Year of Study Term of Study Term of Study Fall Spring Summer Length of Study Length of Study Semester Year Summer Dates of Program #1 Dates of Program #2 (if applicable) Are you a transfer student or have you transferred any credits into DU previously? Are you a transfer student or have you transferred any credits into DU previously? Yes No If so, how many? Emergency Contact Emergency Contact Name Relationship to Student Emergency Contact Address Emergency Contact City, State, ZIP Emergency Contact Email Emergency Contact Home Phone Emergency Contact Work Phone Please list the courses you are proposing to take abroad. Please attach the course descriptions. Title Credit Hours Course Description Course Title Credit Hours Course Description? Course Title Credit Hours Course Description? Course Title Credit Hours Course Description? Course Title Credit Hours Course Description? Course Title Credit Hours Course Description? Course Title Credit Hours Course Description? Additional Comments
