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Wichita State University | International Education | 1845 Fairmount Street | Wichita KS 67260-0122
tele: (316) 978-3232 | fax: (316) 978-3777 | e-mail: international@wichita.edu
Travel Notification Form
Student: ___________________________________________________________________
Family/Last Name First Name
MyWSU ID:___________________________
Email Address: ______________________________________________________________
TRAVEL INFORMATION
Date leaving USA: ___________________ Date returning to USA: ____________________
Destination City & Country (outside USA): ______________________________
EMERGENCY CONTACT INFORMATION (Outside of the U.S.)
Name: _______________________________________________________
Email Address: ________________________________________________
Telephone #:__________________________________________________
Relationship to the person outside the U.S.:_________________________
I hereby certify that the information that I have provided above is true and correct to the best
of my knowledge.
Student’s Signature: __________________________________________
Date:______________
