Name *

First Name

Last Name

Departure Date *

MM

DD

YYYY

Time of Departure *

Hour

Minute

Second

AM PM

Return Date *

MM

DD

YYYY

Time of Return *

Hour

Minute

Second

AM PM

Will you be traveling out of Massachusetts? *

Students who travel outside of Massachusetts are required to inform the Commonwealth of Massachusetts of their return into Massachusetts via the Massachusetts Travel Form. This form can be accessed at https://www.mass.gov/forms/massachusetts-travel-form

Yes

No