STUDY ABROAD

HOST ENROLLMENT VERIFICATION FORM

Name: Banner ID:

Host Institution: Term:

List of courses in which you are currently enrolled:

Course # Course Title Credit Hours

Student Signature Date

Students, please reference your Course Approval Form to ensure that all courses listed above have been pre-approved. It
is your responsibility to contact appropriate department chairs and receive course approval for any unapproved courses.
Any changes to your schedule will require this form to be re-submitted.

TO BE COMPLETED BY HOST INSTITUTION:

Signature of Program Director or On-Site Registrar Date

Print Name and Title

Forms will only be accepted as valid when signed by the on-site Program Director, Coordinator, or Registrar. This
form should be scanned and emailed directly to studyabroad@astate.edu within two (2) weeks of your program start
date.