Dean's Office Study Tour Approval Form

Please do not submit this form without complete information. ALL FIELDS are required.

Name:

Email address:

Cell Phone:

Date of Birth (MM/DD/YYYY):

Please indicate your gender:

Student ID:

Class year:

Major/minor:

GPA:

Are you now or have you been at any time in the past on academic or residence hall probation or suspension?

Yes
No

If you answered 'yes' to the question above, please provide a brief explanation.

Have you at any time been found responsible for a violation of the Loyola Honor Code?

Yes
No

If you answered 'yes' to the question above, please provide a brief explanation

Do you have a valid U.S. passport?

Yes
No

If yes, expiration date:

In 150-300 words, please explain why you would like to go on this tour.