University of Pennsylvania Graduate School of Education
REQUEST FOR DISSERTATION ABROAD REGISTRATION
EDUC 996
Instructions: Please fill in the appropriate information. The term and current registration status
information are required to process the request. Send the completed form to the Student Records
Office, 2nd floor GSE Building, 3700 Walnut Street/6216.
Please note: This form is to be used to request Dissertation Abroad Registration for a maximum
of one academic year.
Student’s Name: ______________________________PennID#: ___________________
Department: _________________________________________ Date: ______________
Present Registration Status:
□ Courses
□ Dissertation
EDUC 996 Registration: Fall Spring Summer Year:_________
Reason for Dissertation Research Abroad Registration:
• Dissertation Research
• Coursework outside of Penn
• Penn Health Insurance
• Other ________________________________________________
Location and description of research:
APPROVAL:
Dissertation Advisor: _________________________________Date: __________
Graduate Group Chair: ________________________________Date: __________
GSE Assistant Dean: _________________________________Date: __________