CoB International Exchange Program Checklist

Outgoing Students

Please print clearly type the request information and return to exchange coordinator.

Name  ___________________________________________________

SS#  ____________________            Semester ___________________

Semester Abroad _____                      Exchange Site _______________

E-Mail _________________________           Current # Credits Earned _____

Home Phone ______________                       Campus Phone _____________

Home Address _____________________________________________

                         _____________________________________________

Campus Address _____________________________________________

                            _____________________________________________

FOR OFFICE USE ONLY:

                                                              Completed                                Date