Spring Semester Leaving Form

Pick One

I will not be attending UW-Stout during the 2013 WinTerM or 2013 spring semester. All of my future classes have been cancelled. I have completed the exit interview here. I will move out of my room no later than 7:00 p.m. Friday, December 21^st.

I will be leaving on:

December

I will be attending UW-Stout during the 2013 WinTerM. I will not attend the 2013 spring semester. All of my spring classes have been cancelled. I have completed the exit interview here. I will move out on the last day of my last WinTerM class.
- My last WinTerM class ends on: January

I am an international student and will not be attending UW-Stout during the 2013 spring semester. All of my future classes have been cancelled. I will move out of my room no later than 7:00 P.M. Friday, December 21^st.

I will be leaving on:

December

I will graduate. I will move out no later than 7:00 P.M. Friday, December 21^st.

I will be leaving on:

December

I have received a co-op or internship that requires living away from Menomonie. I will move out of my room no later than 7:00 P.M. Friday, December 21^st.

I will be living in:

City	State

While working for:

Company Name

I will be leaving on:

December

I will study abroad. I will move out no later than 7:00 P.M. Friday, December 21^st.

I will be living in:

City	Country

I will be leaving on:

December

I will be student teaching away from Menomonie. I will move out no later than 7:00 P.M. Friday, December 21^st.

I will be living in:

City	State

I will be leaving on:

December

Your Info

Name:
Stout E-mail:
ID #:
Your Hall:
Room #:
My room is currently a: Red Cedar Double Single Triple

Confirmation

By checking this box I signify that I am the individual who's name and student ID number appears above and that the information provided is true and accurate to the best of my knowledge.