Travel Endorsement Request
Student Information
Name: ________________________________ UW-Stout I.D. #:__________________
Local Address: _________________________________________________________
Telephone: ____________________ Country Of Citizenship: _____________________
Date of Birth: _____________________ Visa Type _____ F-1 ____ J-1
Student Status & Enrollment
Major: _________________________ Expected Date of Graduation: ______________
Have you maintained your status and enrollment each semester? ____ Yes _____No
Are you eligible to enroll for the next semester? ____ Yes ____ No
Passport Information
Do you need to renew your visa? ____YES ____NO
Do you need a visitor’s visa? ____ YES ____ NO
Do you need to renew your passport? ____ YES ____ NO
Travel Plans
Date departing the U.S.________________________
Date returning to the U.S._______________________
Signature _______________________________________ Date _________________
(To my knowledge, the information above is correct)
STUDENTS WHO ARE TRAVELING BETWEEN SEMESTERS OR DURING THE SUMMER AND HAVE NOT
ENROLLED FOR THE NEXT SEMESTER WILL NOT RECEIVE A SIGNATURE OR BE VALIDATED FOR RE-ENTRY
TO THE UNITED STATES.
Revised 07-09-12