Study Abroad
Student Life Clearance Form

Student Life Clearance Form

All GU students applying to study abroad in any program(s) must receive clearance from the GU Student Life office. Applying for study abroad clearance is one step in the process of applying for a program. Receiving clearance does not automatically mean students are enrolled in the program(s) they have applied for.

Please complete the electronic form below. The information you provide will be directly submitted to the GU Student Life office for clearance. The Student Life office will answer the questions below and provide results to the GU Study Abroad office.

  1. Is the judicial/conduct file for this student clear? If "No", please answer the following:
    1. Have any previous notations/violations been dealt with and considered closed?
    2. Is the student currently under any judicial sanctions? Expiration: _________
    3. Has this student ever been involved in an incident that put themselves or others at risk?
    4. Has this student ever been on probation?
  2. Is the Student Life office aware of any concerns regarding social, behavioral or academic issues that might impact this student’s ability to study abroad successfully?
  3. Does this student have your approval to study abroad?
  4. Please add any additional comments you might care to make concerning this student’s eligibility and/or qualifications for study abroad, or for any clearance changes.
Do Not Edit:
Do Not Edit:
Do Not Edit:
Don't Edit This Field:

Student Personal Information

GU ID Number
First Name:
Middle Name:
Last Name:
Cell Phone Number:
Your Email Address:
Your Current Class Status: Freshman Sophomore Junior Senior

Program Information


Name of First Program:
If you selected "Other Program" - type the name and location of program below:

Term Applying To:
Spring 2013 Summer 2013
Academic Year 2013/2014 Fall 2013 Spring 2014
Name of Second Program:
If you selected "Other Program" - type the name and location of program below:

Term Applying To:
Spring 2013 Summer 2013
Academic Year 2013/2014 Fall 2013 Spring 2014
Name of Third Program:
If you selected "Other Program" - type the name and location of program below:

Term Applying To:
Spring 2013 Summer 2013
Academic Year 2013/2014 Fall 2013 Spring 2014

Complete the Following Question

Are there any factors - academic, social, emotional or behavioral - that might interfere with your success or be a challenge to you if you are allowed to study abroad?
No, there are no factors that might interfere with my success or be a challenge to me if I were allowed to study abroad.
Yes, there are factors that might interfere with my success or be a challenge to me if I were allowed to study abroad.
If yes, please explain below

Authorization To Release Information

Yes, I hereby waive my right to access information on this form and request that it be completed and forwarded to the GU Study Abroad office.

Acknowledgement

By typing my name and the date (MM/DD/YEAR) below, I acknowledge that even after Student Life clears me, any conduct violations prior to departure may result in my clearance status being changed which may lead to my being dropped from the requested program(s). Should this happen, I understand that any financial commitments I have already made toward the program(s), including but not limited to program costs, visas, airfare, etc, will not be reimbursed.
Your full name:    Date (MM/DD/YEAR):