STDYAB myUH ID________________
434 University Drive, Houston, Texas 77204-2010 · Phone (713)743-1010 · Fax (713)743-9098
Welcome Center hours: Monday-Thursday, 8 a.m.-5 p.m.; Friday, 9 a.m.-5 p.m. ·
2020-2021 Learning Abroad Form
The purpose of this form is to adjust your educational cost of attendance with estimated costs abroad. Completion of this form
does not guarantee additional aid. Disbursement of aid will comply with the University’s stated policy and you are responsible
for any charges incurred prior to that date. If courses abroad drop below 12 hours, you may be required to return some or all
your financial aid. *
*Summer course hours may vary.
Student loans require at least 6 hours of enrollment for disbursement during any term, and most university scholarships require a minimum of 12 hours
during fall and spring terms.
A. Student Information
Last Name First Name
ail Address
Student Signature
(blue/black ink, no electronic signatures accepted)
B. Program Information
a. Program Name _____________________________________________
b. P
rogram Start Date ____________ Program End Date ______________
c. How many UH credit hours will you be registered for? ______________
C. Learning Abroad Certification
This section needs to be completed by the individual responsible for the program.
Tuition and Fees
Books and Supplies
Room and Board
Other Associated Costs
(must provide documentation)
I believe these costs to be true and reasonable estimates of the amounts the student will accrue.
Signature of Learning Abroad Advisor Printed Name of Learning Abroad Advisor Date
State law requires that you be informed of the following: (1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form; (2) under sections 552.021 and
552.023 of the Government Code, you are entitled to receive and review the information; and (3) under section 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect.