Pre-College Sign-Out Authorization Request Form
Participants in the Pre-College and Summer Bridge Programs are encouraged to refrain from off-campus visits during the period of the program. We do not permit students to sign-out for overnight visits. Should a participant desire to sign-out for a weekend, completion of this sign-out authorization form will be required.

A program participant will not be permitted to sign-out for more than two (2) weekends. Hampton Harbor Apartments and Heritage Apartments are not authorized sign-out locations. This form must be completed in its entirety to be reviewed.  The deadline to submit this form is May 31, 2024 by 11:59pm.

Please Note: This form is not automatically approved upon submission. Each submitted form will be reviewed by the Pre-College Program Director. Upon review, the program participant and guardian will be notified of request  approval/denial. 

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Student Last Name *
Student First Name *
Student Middle Name *
Student I.D# *
Student Age *
Student's Email Address *
Date Requesting to Leave *
MM
/
DD
/
YYYY
Date Requesting to Return *
MM
/
DD
/
YYYY
Explanation for Weekend Sign-Out *
Parent/Guardian's Telephone Number *
Parent/Guardian's Email Address *
Parent or Guardian's Signature
(*By typing my name I hereby sign this document
 *
Today's Date *
MM
/
DD
/
YYYY
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